Role-modelling and the hidden curriculum: New graduate nurses' professional socialisation

Clinical teachers' perceptions of role modeling: a qualitative study

BACKGROUND

Role modeling has been significantly considered in medical education in recent decades. In the clinical course, students learn necessary skills and accordingly their professional identity is formed by observing and working among clinical educators. Given the importance of the role modeling in medical education, in the present study, it was attempted to explore the clinical teachers' perceptions of being a role model for medical students using a qualitative method.

METHODS

A qualitative design, based on the content analysis approach, was used to analyze the perspectives of 15 clinical teachers. Participants were chosen by purposeful sampling. Data were collected using reflection paper writing.

RESULTS

During the data analysis, five main categories emerged: influencing others, developing different dimensions of student, situational self-awareness, feedback and continuous effort.

CONCLUSIONS

This study will be useful to form role modeling educational programs. Encouraging clinical teachers to make continuous efforts to improve role modeling and educating time management and self-control skills can help reduce the challenges of role modeling for clinical teachers.

Being and becoming a nurse: Toward an ontological and reflexive turn in first-year nursing education

In this paper, we call for an ontological and reflexive turn in first-year nursing education. An ontological turn focuses on formation, the 'being' and 'becoming' of a nurse, and emphasizes the value of nursing knowledge. First-year nursing students often possess romanticized ideals about being a nurse that devalues the knowledge and expertise of nurses. We posit a thoughtful ontological orientation within nursing education that shifts the emphasis toward becoming skillful nurses, with expertise grounded in nursing perspectives. A focus on formation includes discussions regarding ideologies, dominant perspectives, and reflexive explorations of students' views of nursing juxtaposed with the realities of nursing practice. We propose ontologic reflexivity as an approach to consider what perspectives are prioritized (or not) within the nursing classroom. Within pedagogical dialogic spaces, ontologic reflexivity calls on educators to create opportunities for students to learn the value of nursing knowledge along with other forms of knowledge. We consider ways in which an ontological and reflexive turn within the first year of nursing education may contribute to the formation of nursing students who value nursing knowledge, are open-minded to various forms of knowledge, and possess an intentional reflexive way of being.

Solidarity in a Community of Nursing Colleagues

Introduction

Several concepts have been used to describe the qualities of communities of nursing colleagues. Nonetheless, few studies have shed light on nursing communities by drawing on the concept of solidarity.

Objective

To explore solidarity among a community of nursing colleagues.

Methods

A qualitative research design with a reflective life world approach was selected. This study reused data from a larger Norwegian empirical study. The data from the original study consisted of qualitative interviews and follow-up interviews with 13 nurses (RNs). The research context was municipality and specialist health services. A secondary data analysis was conducted. The study was based on the SRQR reporting guidelines.

Results

The results were formulated under two themes: 1) having indispensable relationships and 2) encountering a relative absence of sympathy.

Conclusion

A sense of community among nursing colleagues seems to rely on solidarity: whatever affects one nurse affects another. The solidarity that arose from the content of commonalities involved maintaining indispensable relationships with nursing colleagues by supporting and aiding them and simultaneously enduring a relative absence of sympathy. Solidarity among the community in this study was not a peripheral concept of the general notion of solidarity, implying that the commonalities within the collegial relationships were ambiguous and could shift from something good to something relatively good and vice versa. Such a shift was evidenced by nurses’ experiences of their community.

The transition from nursing student to practicing nurse: An integrative review of transition to practice programs

The transition from student to novice is a difficult time. Although the novice nurse is excited to start working, the nurse struggles with acclimating to a new role with new responsibilities and the need to reconcile disparities between what was taught in school and what is practiced in the real world. To lessen the impact of the transition experience, health care organizations have implemented transition-to-practice programs including orientations, preceptorships, and residencies. Despite these efforts, if the novice nurse does not find these programs helpful, there is still a risk that the transition experience will not conclude with successful results. This integrative review examined qualitative studies that explored the transition-to-practice experience of novice nurses who participated in a transition-to-practice program provided by their place of employment. Thirteen articles met the criteria for this integrative review; seven themes emerged from the commonalities in the studies: socialization, professional growth, feeling supported, transition challenges, reflections, transition shock, and feelings. Though the transition period includes unique experiences for each novice nurse, the common feelings and needs identified in these studies require nurse educators and the healthcare organizations to ensure that novice nurses are prepared and given the tools to successfully transition to professional nursing practice.

Nurses' experiences of being recruited and transferred to a new sub-intensive care unit devoted to COVID-19 patients

Aim

To describe the experiences of Italian nurses who have been urgently and compulsorily allocated to a newly established COVID‐19 sub‐intensive care unit.

Background

In the context of the COVID‐19 pandemic, no studies have documented the experience of nurses urgently reallocated to a newly created unit.

Method

A qualitative descriptive study. Twenty‐four nurses working in a sub‐intensive care unit created for COVID‐19 patients participated in four focus groups. Audio‐recorded interviews were verbatim‐transcribed; then, a thematic analysis was performed.

Results

The experience of nurses was summarized along three lines: (a) ‘becoming a frontline nurse’, (b) ‘living a double‐faced professional experience’ and (c) ‘advancing in nursing practice’.

Conclusions

Nurses who experienced being mandatorily recruited and urgently reallocated to a COVID‐19 unit lived through a mix of negative feelings in the early stages, a double‐faced situation during the episode and, at the end, the perception of global growth as a person, as a team and as a professional.

Implication for nursing management

Nurse managers could play a key role in identifying and preparing nurses in advance to mitigate their concerns and their sense of unpreparedness. The value attributed to nursing care should be promoted both during and after the current COVID‐19 pandemic.

Learning to be a midwife: Midwifery students' experiences of an extended placement within a midwifery group practice

AIM

To investigate the experiences, perspectives and plans of students who had a six-month placement with the midwifery group practice.

METHODS

Focus groups were conducted with fifteen third - year Bachelor of Midwifery students who had undertaken an extended placement at a midwifery group practice in a large tertiary referral hospital in Queensland, Australia.

RESULTS

Four main themes were identified in the data: Expectations of the Placement; Facilitating learning within a midwifery group practice model; Transitioning between models of care and Philosophy and culture of midwifery group practice.

DISCUSSION AND CONCLUSION

Third-year midwifery students valued the experience of working one-on-one for an extended placement with a midwife providing continuity of care within a caseload model. The experience was the highlight of their degree and they learned 'how to be a midwife'. Most students found reintegrating back into the hospital system of care challenging, reporting that their developed skills of supporting women holistically and facilitating normal birth were not fully utilised when returning to the task-orientated birth suite. Students valued thoughtful, kind and supportive midwifery preceptors who supported them to transition back into the hospital.

IMPLICATIONS AND RECOMMENDATIONS

Undertaking an extended placement within a midwifery group practice provides students with a rich and holistic learning experience and helps them develop a sense of professional identity. Student placements situated within models of care which provide continuity of midwifery care should be proactively enabled by health services and universities. Research of the longer-term impacts of an extended midwifery group practice clinical placement on midwifery graduates' capabilities and competencies 3-5 years post registration should be conducted.

Identifying barriers and facilitators to recognition and response to patient clinical deterioration by clinicians using a behaviour change approach: A qualitative study

BACKGROUND

Failure of clinicians to recognise and respond to patient clinical deterioration is associated with increased hospital mortality. Emergency response teams are implemented throughout hospitals to support direct-care clinicians in managing patient deterioration, but patient clinical deterioration is often not identified or acted upon by clinicians in ward settings. To date, no studies have used an integrative theoretical framework in multiple sites to examine why clinicians' delay identification and action on patients' clinical deterioration.

AIM

To identify barriers and facilitators that influence clinicians' absent or delayed response to patient clinical deterioration using the Theoretical Domains Framework.

METHODS

The Theoretical Domains Framework guided: (a) semi-structured interviews with clinicians, health consumers and family members undertaken at two sites; (b) deductive analyses of inductive themes to identify barriers and facilitators to optimal care. This study complied with the COREQ research guidelines.

FINDINGS

Seven themes identified: (a) information transfer; (b) ownership of patient care; (c) confidence to respond; (d) knowledge and skills; (e) culture; (f) emotion; and (g) environmental context and resources.

DISCUSSION

The Theoretical Domains Framework identified traditional social and professional hierarchies and limitations due to environmental contexts and resources as contributors to diminished interprofessional recognition and impediments to the development of effective relationships between professional groups. Communication processes were impacted by these restraints and further confounded by inadequate policy development and limited access to regular effective team-based training. As a result, patient safety was compromised, and clinicians frustrated.

CONCLUSIONS

These results inform the development, implementation and evaluation of a behaviour change intervention and increase knowledge about barriers and facilitators to timely response to patient clinical deterioration.

RELEVANCE TO CLINICAL PRACTICE

Results contribute to understanding of why clinicians delay responding to patient clinical deterioration and suggest key recommendations to identify and challenge traditional hierarchies and practices that prevent interdisciplinary collaboration and decision-making.

Validation of information-seeking behaviour of nursing students confirms most profiles but also indicates desirable changes for information literacy support

Purpose

The study aims were: (1) to replicate a previous study by the first author to confirm previous findings (internal validity) and to check construct validity of previously proposed information-behaviour profiles, (2) to compare the information processes used by students in parallel with requirements of early professional practice.

Design/methodology/approach

A replication study used the same questionnaire, delivered online to all 175 students across three years of a BSc adult nursing degree programme on one UK university campus. The survey included questions on information seeking processes, personality, approaches to learning and self-efficacy with information literacy. The literature review examined evidence around the transition from nursing student to practitioner and the Association for College and Research Libraries (ACRL) standards for nursing information literacy.

Findings

The response rate was 86/175 (49%). The result verified findings on the most frequent information processes and association between approach to learning and information literacy self-efficacy. The personality findings differed. Combining results for both studies helped confirm most of the information-behaviour profiles. Mapping the frequent information processes against requirements of practice indicated gaps, particularly around professional networking.

Research limitations/implications

As both studies were carried out at one higher education campus, further research to assess external validity is required.

Practical implications

Information-behaviour profiles, plus the mapping, help librarians and tutors develop tailored information literacy support that is clinically relevant and support transition to practice.

Originality/value

Validated a set of information behaviour profiles for nursing students and linked these to the requirements of professional practice.

The Glasgow Coma Scale: A European and Global Perspective on Enhancing Practice

Although the Glasgow Coma Scale has made a positive contribution to the care of people with neurologic orders, variance exists in its understanding and application secondary to inconsistency in guidelines, their interpretation, and the educational approach to the use of the tool. This fragmentation has been evidenced to result in variances in practice, some potentially harmful. Also, recent evidence demonstrates human factors, such as distress, have not been addressed within such education and guidelines for use. An opportunity now exists to take a new, unified approach to education and standards for use of the tool, framed within a person-centered context.

Experiences of and support for the transition to practice of newly graduated occupational therapists undertaking a hospital graduate Program

INTRODUCTION

Newly graduated occupational therapists face well-documented difficulties as they embark on professional practice. Occupational therapy departments need to ensure that new graduates conduct their roles appropriately while developing experience and building clinical and professional skills. This study aimed to explore the experiences of new graduates at a major Australian metropolitan hospital occupational therapy department, the support provided to them and their perceptions of this support.

METHODS

The research design was Interpretive Description. Semi-structured interviews of approximately 60 min were undertaken with seven occupational therapists, their team leader and the Departmental Head. The two research questions were as follows: What were the graduates' experiences of their first year in practice? What support was provided to graduates and what were their perceptions of this?

RESULTS

New graduates perceived the transition to practice as overwhelming, particularly regarding their caseload responsibility. During the first few months, work tasks took them longer and they felt stressed and anxious. They received a range of support and education, both inter-professional and discipline specific. Their occupational therapy team leader and clinical senior provided tailored support, guidance and reassurance. Guided questioning facilitated development of new graduates' clinical reasoning and professional skills. Reflection helped them to identify and address learning goals relating to occupational therapy professional competencies. New graduates valued having a consistent caseload and a supportive workplace was highly valued.

CONCLUSION

New graduates initially feel overwhelmed by being responsible for their decisions. However, they can benefit from tailored supervision and guided questioning to help develop clinical reasoning and professional skills, formal and informal support from experienced occupational therapists and their inter-professional teams and time to increase skill with their caseload. Engagement in a professional community of practice is important.

Eliminating horizontal violence from the workplace

The term horizontal violence (HV) is synonymous with nurse-to-peer incivility or bullying. This article examines why HV continues to plague the nursing profession and discusses tools and strategies for eliminating this toxic behavior from the workplace.

Discourse tensions: Professional socialisation into nursing within the university education system

Starting university brings expectations of new experiences and a good social life (Morton and Tighe, 2011), however student nurse experience may not mirror these expectations. The aim of this study was to identify any indications of 'differentness' expressed in students talk, track development and changes in student language over the duration of their programme, and explore how language might situate lecturers and students within a professional socialisation process. Using Discourse Analysis (Potter and Wetherell, 1987), interviews (n = 17) were conducted with 8 lecturers and 7 volunteer student nurses multiple times over 3 years (April 2013 - August 2016). Analysis uncovered three discourse tensions, each showing resonance with students and their lecturers: The university student and the student nurse; The Nursing and Midwifery Council registrant and the lecturer; Student nurses as consumers of their university education. Students did not appear to align themselves with the university after experiencing clinical practice, and lecturers' language attempted to position students away from traditional student experiences to protect professional standards.

Becoming a good nurse - Socialisation of newly employed nurses into the oncological clinic

AIM AND OBJECTIVES

To explore newly employed nurses' socialisation in the process of introduction into an oncological clinic from the perspectives of unit managers and newly employed nurses.

BACKGROUND

There are managerial challenges in retaining nurses at workplaces. The way in which nurses are socialised into their work is important for their job satisfaction and retainment.

METHOD

Qualitative, semi-structured interviews with seven nurses and two unit managers, and written introductory material. Thematic analyses were made, inspired by Goffman's concepts of social interaction, back stage, front stage and roles. SRQR checklist was used.

RESULTS

Unit managers created the framework for socialising newly employed nurses through written introductory guidelines and assignments of supervisors as mainstream role models. Newly employed nurses were socialised gradually through mirroring their supervisors in their role as nurse. Front stage, patients often functioned as objects for newly employed nurses' training. Back stage, patients often functioned as communication objects for all professionals. Newly employed nurses, who also demand roles such as transformer, boss, coordinator, prompter and friend, were socialised into the role of assistant to the doctor. Medical rounds functioned as a socialisator in this process.

CONCLUSION

The allocated supervisors were role models in socialising newly employed nurses into an oncological clinic and its culture. Nurses were socialised into an understanding of care as a biomedical orientation, in which medicine had a higher value than care in the existing knowledge hierarchy at the oncological clinic. This might have implications for who applies for and stays in the job.

RELEVANCE TO CLINICAL PRACTICE

Increased awareness of the importance of socialisation of nurses into the clinic during the introduction process. Re-thinking nurses' independent functions and patient perspectives in introduction of newly employed nurses to maintain and develop nursing as an independent profession.

New graduate registered nurses' experiences with psychological safety

AIM

The purpose of this study was to gain insight into new graduate registered nurses' experiences with psychological safety.

BACKGROUND

Organizational learning allows acute care hospitals to consistently provide high-quality patient care. Psychological safety is critical for organizational learning. New graduate nurses in particular need to feel psychologically safe as they transition into professional nursing practice. Understanding new graduate registered nurses' experiences of psychological safety can guide leaders and others to create work environments that foster psychological safety and organizational learning.

METHOD

Semi-structured interviews were conducted with 13 newly graduated registered nurses working in inpatient hospital settings. Interviews were analyzed using thematic analysis.

RESULTS

Four primary themes featured prominently in the new graduate nurses' experiences of psychological safety: building credibility, making personal connections, feeling supported and seeking safety.

CONCLUSION

Understanding these themes will help nursing education programmes, nurse managers, nurse colleagues and new graduate registered nurses foster psychological safety and create environments conducive to organisational learning.

IMPLICATIONS FOR NURSING MANAGEMENT

All members of the health care team involved in the new graduate registered nurses' transition to practice have a role in fostering psychological safety. Additional research is needed to better understand psychological safety and how to foster it.

Practical nursing students' discursive practices on smoking in Finland

Purpose: Based on focus groups, we analyse how practical nursing students deal with being as smokers and future healthcare workers. The way they justify their smoking is discussed within a group of peers.

Methods: The study has a qualitative design with an inductive approach using focus group interviews (FGIs) for data collection. A total of 29 students were interviewed in five groups of five and one group of four participants.

Results: In the analysis, we found four different discursive practices the students utilized for rationalizing their own smoking and coping with the moral dilemma of smoking in a context of health care where smoking is forbidden: (1) students normalized smoking with references to its prevalence within their social circles, (2) the students asserted that their smoking was under control, (3) students considered themselves responsible smokers, and (4) students identified smoking as a part of their identity.

Conclusion: Training should support the growth of professional identity and address the smoker’s identity right from the start of education. Smokers need special attention in the formulation of professional identity, however, without being stigmatized any further.

The hidden curriculum: Undergraduate nursing students' perspectives of socialization and professionalism

BACKGROUND AND AIM

Nursing students form a professional identity from their core values, role models, and past experiences, and these factors contribute to the development of their professional identity. The hidden curriculum, a set of ethics and values learned within a clinical setting, may be part of developing a professional identity. Nursing students will develop a professional identity throughout school; however, their identity might be challenged as they attempt to balance their core values with behaviors learned through the hidden curriculum. The purpose of this project was to educate students on the hidden curriculum in the development of their professional identity.

MATERIALS AND METHODS

A sample of 112 senior nursing students was recruited from a northeastern university in the United States for this study. Pre-post survey design was used, and an educational session was administered prior to the post-survey. Descriptive statistics and a valid percentage were used to describe the data within the surveys.

ETHICAL CONSIDERATION

Study was approved by the author's University Institutional Review Board.

FINDINGS

A significant finding was for advocacy as students would speak up if witnessing inappropriate behavior toward patients or families with a mean score increase from 2.50 (pre-survey) to 1.45 (post-survey). Also, over 95% (n = 106) found the educational session beneficial as they learned they had the ability to advocate and speak up for their patients.

CONCLUSION

Students were able to use their core values and advocate for their patients and families which allows for safer patient care.

The hidden curriculum in nursing education: a scoping study

CONTEXT

The hidden curriculum is a learning dimension made up of culturally acquired, unintended lessons. Although nurse educators are not fully aware of it, through the hidden curriculum students are prepared for adult professional roles, internalising professional values and developing a professional identity. However, academic nursing education has paid relatively scarce attention to it. The objective was to map the nursing education literature about the hidden curriculum and to identify and verify to which of the four areas suggested by Hafferty (institutional policies, resource allocation decisions, institutional slang and evaluation) it refers.

METHODS

A scoping study was conducted. In July 2018, a search was performed in MEDLINE/PubMed, Scopus, EBSCO/ Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Cochrane Library databases, without time or language restrictions. Two authors independently performed the selection of studies, which followed the preferred reporting items for systematic reviews and meta-analysis (PRISMA) flowchart. Data charting was conducted with both an analytical and a narrative approach.

RESULTS

The study included 18 articles, 13 of which were published during the last 5 years. A total of 12 were research articles, 10 of which used qualitative methodology. Regarding the area of analysis, all four areas could be identified within nursing education literature. The most widely explored area proved to be institutional policies, mentioned by 15 articles, predominantly to highlight the negative effect of the hidden curriculum. Some relational aspects, attributed to the hidden curriculum within nursing literature, belong to the informal curriculum.

CONCLUSIONS

The hidden curriculum in nursing education remains a largely overlooked topic. It appears to be a broader concept than that theorised by Hafferty, often also encompassing the informal curriculum. Furthermore, the literature reviewed mostly highlights the negative consequences of the hidden curriculum, such as the difficulty of transmitting professional values and ethics. Conversely, future researchers should concentrate on its positive consequences as a way to limit the loss of professional values.

The relationship between peer relations, self-rated health and smoking behaviour in secondary vocational schools

AIMS

To examine the association between peer relations, self-rated health and smoking behaviour in vocational school setting.

BACKGROUND

Smoking in adolescence causes health and socioeconomic inequality in adulthood. There is evidence that smokers are physically less active, have lower academic aspirations and perceive poorer health than non-smokers.

METHOD

The study was conducted in spring 2013 and involved 34,776 vocational students who took part in the School Health Promotion Study in Finland. The associations between adolescent smoking habits and peer relations and smokers' self-rated health were studied adjusting for the respondents' age, parental education and family type.

RESULTS

A substantial proportion of the respondents, 37% of the girls and 36% of the boys, reported smoking daily, 15% of the girls and 14% boys smoked occasionally with a further 15% of the girls and 13% of the boys stating that they were ex-smokers. Of the girls, 33% and 38% of the boys were non-smokers. Adjusted multinomial regression revealed that having a close friend or friends predicted smoking among girls and boys. Additionally, the adjusted model indicated that being a bully and/or a bully + bully-victim was associated with smoking behaviour in boys only. Boys and girls who rated their health as moderate or poor were more often daily smokers; in girls, this was also the case in occasional smokers.

CONCLUSION

Smoking prevention aimed at vocational schools should take into consideration the norms and expectations related to peer relations which strongly influence adolescents' smoking habits.

A review of Operating Department Practitioner students' experiences of clinical placements as a result of changing organisations in each academic year

Operating Department Practitioner students as part of their education undertake placements that enable them alongside their academic studies to meet the Health and Care Professions Council Standards of Proficiency; however, like all education providers there was an annual shortage of appropriate placements. As a result, the organisation involved in this review needed to explore an alternative approach to allocating clinical placements. In addition, the course team wanted to change how students gained their clinical skills and possibly increase their understanding of the Operating Department Practitioner role. Traditionally the institution involved (like other Operating Department Practitioner education providers) placed students in one organisation for all of their clinical placements unlike other professions such as nursing who placed students in different areas. The review resulted in students being placed in a different organisation in each year of their course. A qualitative methodology in the form of focus groups was employed to review students' views of the change and their clinical experiences. This resulted in students highlighting areas such as readiness for being qualified and links to evidenced-based practice as benefits of the new system. The review has been successful in terms of placement numbers but also student experiences, although an ongoing review is being undertaken, the change has been successful.

Design and psychometric testing of the attitude towards the prevention of incontinence-associated dermatitis instrument (APrIAD)

Despite the availability of a range of skin care products for the prevention of incontinence-associated dermatitis (IAD), prevalence remains high. Nurses' attitude is an important determinant to take into account in quality improvement projects. This study aimed to design a psychometrically test the attitude towards the prevention of incontinence-associated dermatitis instrument (APrIAD). A prospective psychometric instrument validation study was performed in a convenience sample of 217 Belgian nurses. Construct validity and reliability (internal consistency, stability) were tested. The exploratory factor analysis demonstrated a model consisting of four factors and 14 items: (a) beliefs about the impact of IAD on patients, (b) beliefs about team responsibility to prevent IAD, (c) beliefs about personal responsibility to prevent IAD, and (d) beliefs about the effectiveness of IAD prevention products and procedures. Cronbach's α was 0.72 for factor 1, 0.65 for factor 2, 0.63 for factor 3, and 0.47 for factor 4. The intra-class correlation coefficient was 0.689 (95% confidence interval [CI] 0.477-0.825) for the total instrument, 0.591 (95% CI 0.388-0.764) for factor 1, 0.387 (95% CI 0.080-0.626) for factor 2, 0.640 (95% CI 0.406-0.795) for factor 3, and 0.768 (95% CI 0.597-0.872) for factor 4. Psychometric testing of the APrIAD demonstrated adequate validity and reliability measures.