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

Student nurse socialization: A model of professional discourse adoption

AIM/OBJECTIVE

Through an exploration of student nurses and lecturers' professionalism discourses, this study illuminates influences on professional socialization and offers an appreciation of the processes of language (discourse) adoption involved.

BACKGROUND

Professionalism is a complex concept to define. Nursing research has predominantly explored professionalism in clinical practice; however, the time spent university is key to professional socialization and identity development. Previous research focused on socialization in the clinical area only. This study examined how student nurses and their lecturers construct their talk regarding professionalism while at university.

DESIGN

A social constructionism approach was adopted, where it is assumed that we jointly construct our world on shared assumptions and that language is central to this process.

METHODS

Employing a Discourse and Social Psychology (DASP) approach to discourse analysis, seven nursing students (Adult, Child, and Mental Health fields) and eight lecturers participated in a total of 16 interviews.

RESULTS

The findings indicated participants drew on several interpretative repertoires. These changed over the 3 year degree. Analysis led to development of a Model of Professional Discourse Adoption, illustrating a three phased process, resonating with theories of professional socialization in nursing.

CONCLUSIONS

The study offers insights into how education strategies may support learning and teaching, and professionalism communication.

Does a communication skills program enable symptom and distress screening?: The impact of training on radiation therapists' confidence, knowledge, and use of distress screening

INTRODUCTION

Due to the prevalence of distress following a cancer diagnosis, routine symptom and distress screening is recommended as best practice. RTs perceive psychosocial support and screening to be part of their role, however feel they lack the education and skills to perform this confidently. The study aimed to evaluate the impact of providing communication skills training (RT Prepare CST) on the perceived barriers, knowledge, attitude, role, and confidence of radiation therapists (RTs) in using routine symptom and distress screening.

METHODS

A single-arm, pre-post intervention design was implemented. All RTs at one regional and one rural centre participated in RT Prepare CST. RTs completed a questionnaire: pre-intervention (T1); immediately post-intervention (T2); and, three months post-intervention (T3). Cochran's Q and McNemar's tests for non-parametric data were conducted to compare outcomes over time.

RESULTS

Of 39 RTs approached, 37 (95%) consented to participate with 36 (92%) completing questionnaires at all three time points. Significant and sustained improvements post-intervention were noted from T1-T3 including: confidence in describing the PROMPT-Care tool to patients (p=0.002), discussing psychosocial issues (p=0.014); recognising signs of anxiety/depression (p<0.001); dealing with signs of anxiety (p=0.002), depression (p=0.015) and distress (p=0.008) as well as agreeing 'the tool is useful in identifying psychosocial problems' (p=0.029).

CONCLUSIONS

RT Prepare CST was effective in increasing confidence, knowledge and attitudes of RTs in the psychosocial care of patients with a change in RT behaviour noted by a significant increase in the number of patients screened following the intervention. Providing routine CST and emotional cues training to RTs enhances their ability to care for patients holistically, equipping them with skills to be included within a psychosocial model of care. Engaged leadership and role models are essential to sustain the learnings from education programs and provide an environment to discuss and define roles within radiation therapy departments.

Professional socialization: an analytical definition

Professional socialization is defined as a process through which a person becomes a legitimate member of a professional society. This will have a great impact on an individual’s professional conduct and morality. The aim of this study was to clarify this concept and reduce the ambiguities around it.

This was a qualitative research through which the concept of professional socialization was analyzed using Walker and Avant’s eight-step approach. The review of literature for this concept was done using electronic database without any time limitation. The overall search produced about 780 articles, and after reviewing these articles, 21 were selected purposefully.

Based on concept analysis, we propose the following analytical definition: Professional socialization is a nonlinear, continuous, interactive, transformative, personal, psychosocial and self-reinforcing process that is formed through internalization of the specific culture of a professional community, and can be affected by individual, organizational and interactional factors. This definition is in accordance with the interactionism perspective. Existence of a particular profession and getting involved in a community of practice are the antecedents of this process, and formation of professional identity and professional development are its consequences. A case model, as well as borderline and related cases, has been introduced for this concept. The results of this study can be used to design useful educational interventions to conduct and facilitate the process.

An Investigation of Professional Integrity in Pre-registration Nurse Education: A Modified Grounded Theory Research Study

BACKGROUND

Acting with integrity is a central part of nursing practice. However, literature shows that professional integrity can be absent and where this is present it can face challenges. Governmental Inquiries have revealed deficits in the expression of nursing values which underpin professional integrity, in particular caring, compassionate and competent practice that maintains the dignity of patients. Evidence also suggests that it cannot be taken for granted that pre-registration education will have a positive impact on student nurses' ability to practice with integrity.

OBJECTIVES

This research explored students', mentors' and lecturers' experiences of professional integrity in pre-registration nurse education.

METHODOLOGY

A grounded theory approach was informed by the work of Charmaz (2004, 2006).

CONTEXT

The study, which took place in a UK university, involved four fields of nursing practice: Adult, Children, Mental Health and Learning Disabilities.

PARTICIPANTS

12 student nurses, 5 practice-based mentors and 6 lecturers participated.

FINDINGS

Semi-structured interviews and focus groups revealed three main themes: meanings, enactment and growth of professional integrity.

CONCLUSIONS

Pre-registration education can influence the growth of professional integrity by improving students' understanding of the boundaries of nursing practice and potential threats to these, skills to speak up on behalf of patients, and knowledge of the processes involved in raising concerns about practice and potential barriers to this. The proactive development of student nurses' strategies to cope, alongside increasing their understanding of the importance of this is also likely to be beneficial.

A Scoping Review of Peer-led Education in Patient Safety Training

Objective. To examine the literature pertaining to the use of peer-led education in patient safety. Findings. Four studies met the inclusion criteria: two were conducted in health care students and two in medical practitioners. Three studies used pre-post evaluation, with one containing a comparator group. One study a post-intervention evaluation only. All studies undertook Kirkpatrick Level 2 evaluations, showing significant improvements in attitudes and knowledge. One study undertook Level 3 and 4 evaluations, showing improvement in self-reported behaviors and engagement in quality improvement initiatives. Summary. There are few studies evaluating peer-led education in patient safety and formal and high-quality evaluations are lacking.

Evaluating the Effectiveness of an Educational Intervention to Improve the Patient Safety Attitudes of Intern Pharmacists

Objective. To evaluate the effectiveness of a face-to-face educational intervention in improving the patient safety attitudes of intern pharmacists. Methods. A patient safety education program was delivered to intern pharmacists undertaking The University of Sydney Intern Training Program in 2014. Their patient safety attitudes were evaluated immediately prior to, immediately after, and three-months post-intervention. Underlying attitudinal factors were identified using exploratory factor analysis. Changes in factor scores were examined using analysis of variance. Results. Of the 120 interns enrolled, 95 (78.7%) completed all three surveys. Four underlying attitudinal factors were identified: attitudes towards addressing errors, questioning behaviors, blaming individuals, and reporting errors. Improvements in all attitudinal factors were evident immediately after the intervention. However, only improvements in attitudes towards blaming individuals involved in errors were sustained at three months post-intervention. Conclusion. The educational intervention was associated with short-term improvements in pharmacist interns' patient safety attitudes. However, other factors likely influenced their attitudes in the longer term.

The Heroic and the Villainous: a qualitative study characterising the role models that shaped senior doctors' professional identity

BACKGROUND

The successful development and sustaining of professional identity is critical to being a successful doctor. This study explores the enduring impact of significant early role models on the professional identity formation of senior doctors.

METHODS

Personal Interview Narratives were derived from the stories told by twelve senior doctors as they recalled accounts of people and events from the past that shaped their notions of being a doctor. Narrative inquiry methodology was used to explore and analyse video recording and transcript data from interviews.

RESULTS

Role models were frequently characterised as heroic, or villainous depending on whether they were perceived as good or bad influences respectively. The degree of sophistication in participants' characterisations appeared to correspond with the stage of life of the participant at the time of the encounter. Heroes were characterised as attractive, altruistic, caring and clever, often in exaggerated terms. Conversely, villains were typically characterised as direct or covert bullies. Everyday events were surprisingly powerful, emotionally charged and persisted in participants' memories much longer than expected. In particular, unresolved emotions dating from encounters where bullying behaviour had been witnessed or experienced were still apparent decades after the event.

CONCLUSION

The characterisation of role models is an important part of the professional identity and socialisation of senior doctors. The enduring impact of what role models say and do means that all doctors, need to consistently reflect on how their own behaviour impacts the development of appropriate professional behaviours in both students and training doctors. This is especially important where problematic behaviours occur as, if not dealt with, they have the potential for long-lasting undesirable effects. The importance of small acts of caring in building a nurturing and supportive learning atmosphere at all stages of medical education cannot be underestimated.

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

Aims and objectives

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

Background

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

Design

This is a critical review of organisational socialisation literature.

Methods

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

Conclusions

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

Relevance to clinical practice

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

Caring for attitudes as a means of caring for patients--improving medical, pharmacy and nursing students' attitudes to each other's professions by engaging them in interprofessional learning

INTRODUCTION

Negative attitudes between pharmacists, doctors and nurses can impact adversely on patients' medicines management. A seven-week interprofessional learning (IPL) intervention was delivered to foster positive attitudes.

METHODS

First-year pharmacy, nursing and medical students' attitudes were assessed using the Attitudes to Health Professionals Questionnaire before and after IPL intervention.

RESULTS

Students viewed pharmacists, doctors and nurses as more 'caring' after IPL. Nurses were viewed as most 'caring'. Nursing and pharmacy students perceived doctors as least 'caring' before and after IPL whereas medical students viewed pharmacists as least 'caring'. Students perceived their own profession as more 'caring' than others did. The three-way analysis of variance showed a significant difference between student groups (p<0.0001), professions (p<0.0001) and before-and-after IPL (p<0.005).

CONCLUSION

Findings suggest that students' attitudes are more positive after they have worked together during seven weeks of IPL. Each student group view their own profession more positively than others. Views become more aligned after this IPL intervention. Time may be an important factor in allowing for attitudes to change. IPL can help foster positive attitudes between doctors, pharmacists and nurses, which may facilitate effective collaboration and thus enhance patients' medicines management.

Registered nurses' personal responses to postoperative pain: a descriptive qualitative study

This paper explores if nurses' personal responses to postoperative pain contribute to its continuing poor management. A descriptive qualitative design used a purposive sample of 16 registered nurses (RNs), from inpatient surgical areas in the United Kingdom, to participate in one semistructured interview. These were recorded and transcribed verbatim. Analysis used Morse and Field's four stages. A complex picture of collective and individual responses emerged; uncritical adoption of the medical model, with pain as normal and focus on technical aspects of management conforming to a "reference typology." However, individual RNs were also influenced by other personal factors, and findings indicate that scrutinizing individual competency is essential to improve individual and collective practice.

Concept analysis of professional socialization in nursing

PURPOSE

The aim of this study is to clarify the process of professional socialization, and to identify its attributes, antecedents, and consequences in nursing. Rodgers' evolutionary method of concept analysis was used to clarify the concept of professional socialization in the field of nursing.

SOURCE

A literature review was conducted by performing a search on scientific databases using the key terms "socialization," "professional socialization," and "nursing." Four hundred forty-six papers for the period 1995-2009 were found, out of which 47 articles and 4 books were selected for the analysis. The process was audited by two independent experts in order to ensure neutrality and credibility.

CONCLUSION

Professional socialization is a complex process with four critical attributes: learning, interaction, development, and adaptation. Comprehensive educational programs, competent role models, and the provision of adequate field experiences were found to be the antecedents of these attributes. They have either positive or negative consequences for the professional development of nurses. These findings not only add to the body of knowledge, but also serve as an important impetus for further theory development and research in nursing.

Resilience to care: a systematic review and meta-synthesis of the qualitative literature concerning the experiences of student nurses in adult hospital settings in the UK

AIM

The aim of the study was to gain new insights into the experiences and accounts of adult pre-registration student nurse clinical allocations in hospital settings in the UK.

DESIGN

A systematic review and meta-synthesis of the qualitative literature was undertaken.

DATA SOURCES

Pertinent papers published from 1990 to 2010 were identified through searches of Cumulative Index for Nursing and Allied Health Literature, Proquest, Medline (PubMed), and the British Nursing Index. Hand and citation searching was also undertaken.

REVIEW METHODS

Ten relevant papers were identified for review. Quality checks on the robustness of the studies were undertaken. Data extraction included identifying details of the study's settings, sample details, focus of the study, research design, data collection methods, data analysis approaches and qualitative data themes.

RESULTS

Approximately 40 qualitative data themes were identified and were the subject of a meta-synthesis. Five cross-cutting synthesised data themes were identified including: pre-placement anticipation, the realities of the clinical environment, clinical learning and becoming a nurse. Stress and coping was a concurrent topic area and related to all the synthesised themes.

CONCLUSIONS

The findings give new insights into the clinical experiences of student nurses of which the stress of learning in clinical environments and the development of emotional resilience is a focal issue. Whilst the majority of students in the UK experience nurturing, caring clinical environments and positive staff relationships, however, some do not. Reports of negative student nurse clinical experiences are shown in this review to have endured through time. Nurse educators should be alert to the possibility that some students may have very negative clinical experiences. The consequences such negative experiences will affect such things as increases to student attrition and the help perpetuate the cycle of negative clinical learning experiences occurring in the future.

Professional socialization in dietetics: a review of the literature

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

Addressing the midwifery workforce crisis: evaluating an employment model for undergraduate midwifery students at a tertiary maternity hospital in Melbourne, Australia

BACKGROUND AND AIMS

In Victoria, maternity services are under significant strain due to increased numbers of women giving birth and critical workforce shortages. Hospitals have experienced challenges in adequately staffing maternity units, particularly on postnatal wards. In 2008, a tertiary maternity hospital in Melbourne introduced a model where undergraduate midwifery students were employed as Division 2 nurses (SMW_Div2) (enrolled nurses), to work in the postnatal area only. This study explored the pilot employment model from the perspective of the SMW_Div2 and hospital midwives.

METHODS

A web-based survey was administered to hospital midwives and the SMW_Div2s in the employment model in January 2010. The survey explored the views of midwives and SMW_Div2s regarding the perceived impact of the model on workforce readiness, recruitment and retention, and clinical competence and confidence.

FINDINGS

Forty-seven of 158 midwives (30%) and five of nine SMW_Div2s employed in the model responded to the survey. Both groups considered the model to have benefits for the organisation, including increased: student workforce readiness; clinical confidence and competence; and organisational loyalty. Both groups also considered that the model would facilitate: workforce recruitment; a teaching and learning culture within the organisation; and enhanced partnerships between students, hospitals and universities. Caution was expressed regarding workload and the need for ongoing support for SMW_Div2s working in the model.

DISCUSSION AND CONCLUSION

SMW_Div2s and midwives were positive about the introduction of the paid employment model at the Women's. The findings are consistent with evaluations of similar programs in the nursing setting. The employment model has potential short and long term individual and organisational advantages, which is important in the context of increasing births and workforce shortages. Progression of such models will be contingent on the collaboration and cooperation of the various stakeholders involved in maternity workforce and education.

"This is nursing": nursing roles as mediated by precepting nurses during clinical practice

In nursing education, it has been argued that professional socialization is facilitated by clinical experiences where students work together with precepting nurses. However, few studies found have focused on how nurses think and act as preceptors, hence providing a base for professional socialization to occur. Therefore; this study aimed to describe how preceptors mediated nursing as a profession to undergraduate nursing students during clinical practice. This was an ethnographic study guided by symbolic interactionism. A purposeful sampling of 13 precepting nurses was observed during the field work period. In addition, 16 staff nurses, purposively selected, and experienced in precepting, participated in focus group interviews. All text from field notes and interviews were read as a whole and analyzed following the ethnographic approach. Findings illustrated how nursing was mediated as the medical-technical, the administrative, and the caring role. Preceptors aimed for professionalism in their students by teaching the students to reflect on what they can do independently as nurses. Preceptors strived to verbalise their practical knowledge to make theory explicit and contextualize to student nurses. This knowledge can guide implementation of preceptor programmes focusing on the meaning and implications of professionalism.

Empathic anger in junior nursing students

The ideal clinical experience fosters development of psychomotor, cognitive, and affective skills while affording initial socialization into the profession. It is expected that during these experiences, nursing students will encounter illustrative exemplars of caring and professional values. The primary stressors during initial clinical experiences arise from issues related to performance and socialization. Nursing students view a good relationship with the RNs at the clinical site as the most crucial influence on their professional growth and development. Even more distressing to students than being treated poorly themselves is watching patients receive uncaring treatment. Students' sadness and anger provoked by perceived uncaring treatment blends to form empathic distress. A content analysis of an assigned narrative from junior nursing students explores empathic anger experienced by the students during their initial clinical rotations.

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

CONTEXT

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

OBJECTIVE

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

DESIGN

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

SETTING

An accredited undergraduate athletic training education program.

PATIENTS OR OTHER PARTICIPANTS

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

DATA COLLECTION AND ANALYSIS

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

RESULTS

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

CONCLUSIONS

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

What is the impact of theoretical knowledge on children's nurses' post-operative pain management practices? An exploratory study

Despite the availability of the evidence to guide pain management practices, practices are often sub-optimal with children experiencing moderate to severe pain post-operatively. Limited theoretical knowledge about managing pain has been suggested as one reason for this. Several studies have identified gaps in nurses' theoretical knowledge. However, the affect of theoretical knowledge on pain management practices has not been explored. This explored whether there is a relationship between nurses' theoretical knowledge and the quality of their practices. Nurses (n=13) on one children's surgical ward were shadowed for a five-hour period during two-four shifts. Data about post-operative pain management practices were collected using a pain management checklist and field notes. Nurses (n=12) also completed the revised pain management knowledge test. Questionnaire scores were compared to the observational data. No positive relationship was found between nurses' level of theoretical knowledge and how well they actually managed pain. Nurses did not appear to routinely apply theoretical knowledge in practice. This may explain, at least in part, why pain management practices remain poor despite the evidence to guide practice being readily available. The hypothesis, put forward in other studies, that increasing nurses' theoretical knowledge about pain will improve practices may be overly simplistic.

Exploring the transition and professional socialisation from health care assistant to student nurse

BACKGROUND

Minimal research is available examining the socialisation process from the perspective of students with health care knowledge who prior to undertaking their training worked as a health care assistant (HCA). The transition and professional socialisation process undertaken by students is an important factor in contributing to the successful completion of a pre-registration nursing programme. Despite this, limited empirical research explores the impact prior health care knowledge plays in this process.

OBJECTIVE

The studies aim was to determine the transitional processes associated with moving from a HCA to Student Nurse.

DESIGN

A descriptive qualitative study undertaken over an 8-month period at a university in the northeast of England.

POPULATION, SAMPLE, SETTING

A homogeneous sample of 14 students with previous experience as a HCA within the field of adult nursing was used.

METHODS

Data were collected through 4 focus group interviews and analysed using [Burnard, P., 1991. A method of analysing interview transcripts in qualitative research. Nurse Education Today 11, 461-466.] thematic content analysis.

FINDINGS

The main themes that emerged around culture shock and clinical issues identified both positive and negative perceptions upon this process. Equally a new concept is introduced from the findings, that of 'the comfort zone', which explores the intentional reversal into the HCA role by the participants of the study. From the findings a framework for the transition and professional socialisation from HCA to student nurse is provided. The findings will assist the university and others in identifying, addressing and aiding the socialisation needs of these students into their new role as a student nurse.

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

AIM

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

BACKGROUND

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

METHODS

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

FINDINGS

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

CONCLUSION

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

Role discrepancy: is it a common problem among nurses?

AIM

This paper reports a study of nurses' perceptions of the differences between ideal and actual nursing roles, how these perceptions differ according to length of experience and the factors that might contribute to these perceived differences.

BACKGROUND

The literature suggests that nurses tend to experience role discrepancy or a mismatch between their ideal and actual roles. Although it has been assumed that experienced nurses perceive less role discrepancy than inexperienced nurses, either because the former adjust themselves to their actual practice or because they have the expertise to improve their practice, this assumption has not been tested.

METHODS

A survey design was used and the data were collected in 2003. Selected items from the Jefferson Survey of Attitudes Toward Physician-Nurse Inventory and the Staff Nurse Role Conception Inventory were administered to 216 Registered Nurses in Victoria, Australia to measure their perceptions of ideal and actual nursing roles. Data were analysed using a t-test and regression analysis.

RESULTS

Nurses with more clinical experience rated their ideal and actual nursing roles more positively than those with less experience. However, the results showed that both groups of nurses experienced the same degree of role discrepancy. Both groups perceived strong role discrepancy in the areas of organizational decision-making and provision of patient education. Experienced nurses also perceived moderate role discrepancy in developing nursing care plans and in the freedom to initiate referrals.

CONCLUSIONS

Role discrepancy cannot be resolved by having more clinical experience. While clinical experience enhances nurses' conceptions of their ideal roles, it can also lead to role discrepancy if there are organizational barriers that prevent nurses from engaging in their ideal roles. It is important to find a way whereby nurses can actualize their ideal views of practice in the current healthcare environment.

Children's nurses' post-operative pain management practices: an observational study

BACKGROUND

Children continue to experience unrelieved moderate to severe pain post-operatively despite the evidence to guide practice being readily available. Previous studies have relied on self-report measures; there is a need to establish exactly how nurses manage children's pain in practice.

OBJECTIVES

To ascertain how nurses actually manage post-operative pain in children and whether pain management practices adhere to current best practice guidelines.

DESIGN

An observational study was carried out. Structured and unstructured data were collected.

SETTING

A children's surgical ward in the English Midlands caring for children from birth to 16 years.

PARTICIPANTS

Registered nurses (n=13) took part in the study.

METHODS

Each participant was observed continuously for a period of 5 hours per shift for two to four shifts each. The role of the observer as participant was adopted whereby the researcher could shadow the nurse and act primarily as an observer. Data were collected for 36 shifts (185 hours).

RESULTS

While nurses administered analgesic drugs when a child complained of pain, in most other areas practices did not conform to current recommendations and are in need of improvement. Nurses did not, for example, routinely assess a child's pain, nor use non-drug methods of pain relief on a regular basis.

CONCLUSIONS

The sub-optimal pain management practices may be attributable to several factors. The professional culture of nursing and/or ward culture may result in poor pain management practices being perpetuated. Nurses may not have the requisite theoretical knowledge to manage pain effectively. A lack of priority may also be attributed to pain management. These areas need exploring further.

A systematic review of evidence on the professional practice of the nurse and developing and sustaining a healthy work environment in healthcare

OBJECTIVES

The overall aim of this systematic review was to identify the best available evidence on the relationship between the knowledge, competencies and behaviours of nurses exhibiting professional practice in their workplace; and the development of a healthy work environment.

SEARCH STRATEGY

The search strategy sought to find both published and unpublished studies written in the English language. An initial limited search of MEDLINE and CINAHL databases was undertaken to identify optimal search terms. A second extensive search using all identified key words and index terms was then undertaken.

METHODOLOGICAL QUALITY

Two independent reviewers assessed the methodological quality of retrieved papers using the corresponding checklist from the System for the Unified Management, Assessment and Review of Information (SUMARI) package.

RESULTS

Of the 4238 papers found in the search: 219 were selected for full paper retrieval; 19 of these papers were unable to be located; 200 full papers were assessed for methodological quality; 181 studies were excluded; and 19 were included in the review. Of these 19, four quantitative studies evaluated a professional nursing practice model and its impact on a variety of outcomes; five descriptive studies examined elements of nurses' professional practice and the impact these elements had on specified outcomes; and 10 qualitative papers examined varying behaviours, competencies and knowledge levels of nurses. Various methods were used, such as focus groups and open-ended interviews. Overall, the evidence suggests that professional practice has a positive impact on the work environment in terms of nurses' role satisfaction and patient outcomes. The evidence is, however, equivocal in many areas and the impact of the professional practice of the nurse requires further investigation.

CONCLUSION

The results of the review suggest a number of recommendations for practice and research on creating a healthy work environment.

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

BACKGROUND

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

OBJECTIVES

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

SETTING

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

METHODS

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

RESULTS

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

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

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

Negotiating socialisation: the journey of novice nurse academics into higher education

In this paper we seek to explore the socialisation process experienced by novice nurse academics when they make the transition from the health sector into the education sector. We will do this by identifying the theoretical tensions between individual freedom in the context of organisational needs. The ramifications of these tensions will be highlighted and solutions for raising awareness as to how to manage them are discussed. We conclude that a socialisation process that protects individual freedom and promotes self-development is one that carries the greatest benefit for the novice nurse academic and the educational institution.

The Competence of Nursing Graduates from Problem-Based Programs in South Africa

Although a significant body of research regarding problem-based learning (PBL) programs has been conducted during the past 2 decades, most of it relates to medical students and their curricula. There has also been very little research in the context of developing countries. In South Africa, most of the students who are admitted into nursing programs are from disadvantaged backgrounds, and it is important to assess the extent to which process-based curricula are appropriate for this group. The purpose of this study was to describe and evaluate the outcomes of PBL programs in nursing schools in South Africa in terms of the actual clinical practice and competence of graduates, and to compare these outcomes with those of graduates from conventional programs. The objectives of the study were to identify the characteristics of practice of graduates from PBL and conventional schools of nursing in South Africa, as described by the graduates and their supervisors, and secondly, to compare the practice characteristics of the two groups.

Mental health practice and the rhetoric-reality gap

This paper had its genesis in a national project, sponsored by the English National Board for Nursing, Midwifery and Health Visiting, to explore team working within mental health practice. The project extended over a 2-year period and utilized various methods of data collection. However, this paper focused on data, from the national survey and informal interviews (based in eight regions), that addressed specific issues within the practitioner group. Of the 800 questionnaires sent out 26% were returned. Fifty-three percent of the returns were from practitioners, 14% user/carers and 33% educationalists. Our focus was that of the practitioners. This group had a response rate of 50% (i.e. 50% of the surveys sent out to practitioners were returned). A content analysis of 100 interviews was used to triangulate the data. Whilst the original brief was to explore team working the survey also highlighted data that indicated a common understanding of what mental health practitioners do and what they say they do and that, although there was a commonality of vocabulary, different practices existed between and within regions. This is the focus of this paper. We argue, from our findings, that different practice is a result of 'habitus'. Whilst practitioners reported that they subscribe to a national agreement of meaning, there is a rhetoric-reality gap: that which is said to be done is not what is, in fact, practised. At the local level we argue that working within the habitus (educationally) can address the rhetoric-reality gap. However, we recommend further studies in order to explore how working within the habitus can address this matter across regions.

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

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

A phenomenological study of early nursing experiences in Hong Kong

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

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

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

An exploratory study of similarities and differences between senior students from different pre-registration nurse education courses

A triangulation design using two simulations, non-participant observation and a semi-structured interview to explore senior student nurse performance in South East England is described. A comparison of student nurse performance (registered general nurse [RGN] programme n = 34; registered nurse Project 2000 diploma programme n = 34; integrated degree programme n = 31) indicated many similarities but also some important differences in outcomes which included: a more systematic approach to information-seeking, better care-planning skills and higher quality nurse performance among integrated degree programme participants; use of a model and the immediate role of the nurse to guide information-seeking and better care-planning skills and weaknesses in clinical nurse performance among RGN programme participants; and weaknesses in the information-seeking, care-planning and clinical nurse performance among Project 2000 diploma participants. There were no significant differences between the clinical performance scores of the RGN and diploma programme participants. The interview data suggested that the integrated degree programme participants had a client focus in contrast to the professional focus of RGN and Project 2000 diploma participants. The findings, however, must be viewed within the context of an exploratory study of limited sample size. The research was funded by the English National Board for Nursing, Midwifery and Health Visiting.