Development and psychometric testing of the Belongingness Scale–Clinical Placement Experience: An international comparative study

Belonging in Surgery: A Validated Instrument and Single Institutional Pilot

OBJECTIVE

The aim of this study was to develop and validate an instrument to measure Belonging in Surgery among surgical residents.

BACKGROUND

Belonging is the essential human need to maintain meaningful relationships and connections to one's community. Increased belongingness is associated with better well-being, job performance, and motivation to learn. However, no tools exist to measure belonging among surgical trainees.

METHODS

A panel of experts adapted a belonging instrument for use among United States surgery residents. After administration of the 28-item instrument to residents at a single institution, a Cronbach alpha was calculated to measure internal consistency, and exploratory principal component analyses were performed. Multiple iterations of analyses with successively smaller item samples suggested the instrument could be shortened. The expert panel was reconvened to shorten the instrument. Descriptive statistics measured demographic factors associated with Belonging in Surgery.

RESULTS

The overall response rate was 52% (114 responses). The Cronbach alpha among the 28 items was 0.94 (95% CI: 0.93-0.96). The exploratory principal component analyses and subsequent Promax rotation yielded 1 dominant component with an eigenvalue of 12.84 (70% of the variance). The expert panel narrowed the final instrument to 11 items with an overall Cronbach alpha of 0.90 (95% CI: 0.86, 0.92). Belonging in Surgery was significantly associated with race (Black and Asian residents scoring lower than White residents), graduating with one's original intern cohort (residents who graduated with their original class scoring higher than those that did not), and inversely correlated with resident stress level.

CONCLUSIONS

An instrument to measure Belonging in Surgery was validated among surgical residents. With this instrument, Belonging in Surgery becomes a construct that may be used to investigate surgeon performance and well-being.

Nursing students who identify as men; efficacy and persistence

AIM

To evaluate the efficacy of nursing students who identify as men and its correlation with intent to complete their nursing program.

BACKGROUND

Men are an underrepresented population in nursing, despite mandates to improve the diversity of the nursing profession. There also exists a nursing shortage, that is worsening as nurses retire or change professions. Improving the recruitment and retention of men in nursing could have a positive impact on both of these problems.

DESIGN

Quantitative correlational research METHODS: The Belongingness Scale-Clinical Placement Experience instrument was used to measure efficacy and one item from the Undergraduate Nursing Intention Survey was used to measure the student's intent to complete their nursing program. A SurveyMonkey link was sent by the National Student Nursing Association to those students who identified in their database as men and were enrolled in a Bachelor of Science in Nursing program. The inclusion criteria required that the participants identified as a man, were a student in a Bachelor of Science in Nursing program and they had one or more years of clinical experience in their nursing program. Students who have completed one or more years of clinical experience, have completed all nursing pre-requisites and a portion of their nursing courses. At this point in a nursing program, the students' age would be 18 years of age or older. Inclusion criteria or 18 years of age or older would also make the consent process easier, as the study would not include a vulnerable population.

RESULTS

There were 290 responses, 252 of which met inclusion criteria and completed the survey in its entirety. The dependent variable, student intent to complete their nursing program, was not normally distributed. For this reason, Spearman's correlation and eta squared were used for statistical evaluation. Spearman's correlation was significant at 0.05 and eta squared demonstrated effect size at 0.01, 0.06 and 0.14 for small, medium and large effect sizes, respectively. Spearman's rho, p=0.147, demonstrated a correlation between efficacy and student intent to complete their nursing program. The eta squared effect size was 0.96 which represented a large effect.

CONCLUSIONS

Nursing students who identify as men could demonstrate improved persistence in their nursing programs if effective interventions targeting efficacy were undertaken.

'Experiencing one thing and saying another'-Ecological Momentary Assessment (EMA) of nursing students' competence and challenge during clinical placements compared with retrospective interviews

Clinical placements are essential to nursing education and understanding students' challenges in the clinical context is important for educators. Nevertheless, few studies have investigated students' experiences in the clinical context itself but rely on methods which ask participants to generalize their clinical experiences retrospectively.

OBJECTIVES

This study aimed to explore nursing students' experiences of clinical activities during and after clinical placements with a focus on feelings of competence and challenge. A particular interest was on comparing momentary assessments in the clinical context with retrospective interview data.

METHODS

Smartphones were used for ecological momentary assessment of students' experiences of clinical activities during five-week placements at 21 nursing homes. Both quantitative and qualitative data were collected. Interviews were conducted after the placements.

RESULTS

575 responses were obtained showing final-year nursing students rated their competence significantly higher and challenge significantly lower than first-year students. An analysis of the quantitative data using the four-channel flow model showed that first-year students' activities were to a significantly higher extent associated with flow and anxiety, compared to those of final-year students. Conversely, the final-year students' activities were to a significantly higher extent associated with boredom than those of first-year students. The analysis of the students' reflections resulted in five themes: Specific activities are challenging, Lack of challenge, Learning and developing, Reflects critically on competence, and Arrangement of the clinical placement.

DISCUSSION

Final-year nursing students were significantly less challenged during the placements compared to first-year students. There was overlap in how students described their clinical experiences during and after placements, but there were also striking differences. The first-year students were overwhelmed by the challenges during the placements but viewed these experiences as valuable learning experiences afterwards. The final-year students also described several challenging clinical activities during the placements but none of these challenges were brought up afterwards in the interviews and instead a lack of challenge was emphasized. Momentary assessment thus enabled capturing data about clinical activities which may be overlooked by retrospective methods.

Relationship between clinical belonging, professional identity, and nursing information ability among nursing interns: Model construction

BACKGROUND

Clinical belonging refers to the feeling that clinical medical staff feel recognized and accepted by others or groups. The level of clinical belonging of nursing interns affects students' learning motivation and confidence, which in turn affects their clinical practice behavior.

AIM

To explore the effects of professional identity and nursing information ability on clinical belonging among nursing interns and establish a relationship model for these factors.

METHODS

The researchers used the convenience sampling method to select 682 nursing interns from China. The survey was conducted using a general information questionnaire, clinical sense of belonging scale, nursing information ability self-assessment scale, and a nursing student professional identity questionnaire. The mediating effect of nursing information ability between their professional identity and clinical sense of belonging was analyzed using SPSS 21.0 and the path analysis in structural equation modeling.

RESULTS

The total scores of clinical belonging, professional identity, and nursing information ability of nursing interns were (104.29 ± 13.11) points, (57.89 ± 7.16) points, and (70.29 ± 6.20) points, respectively. Nursing information ability had a direct effect on the clinical sense of belonging (effect value = 0.46, P < 0.05). Occupational identity had a direct effect (effect value = 0.52, P < 0.05) and an indirect effect (effect value = 0.21, P < 0.05) on clinical belonging.

CONCLUSION

Nursing administrators in nursing colleges and hospitals should take effective measures to improve the professional identity and nursing information ability of nursing interns, as well as the clinical sense of belonging among nursing interns.

Lessons Learned From Early Undergraduate Exposure to the Medical School Curriculum: A Qualitative Analysis

BACKGROUND

 Students considering the health profession as a career rarely have an opportunity to explore medical school experiences. Pathway programs and "mini-medical school" programs exist but rarely involve integrating participants into the medical school experience. A novel for-credit undergraduate course was developed to embed students into a clinical skills course for medical students beginning in 2013. To better understand the impact of these experiences, this study explored former students' perceptions and career trajectories.

METHODS

Participants were contacted via email to participate in a virtual, semi-structured interview. Virtual interviews were recorded and transcribed verbatim. Three investigators analyzed 17 interview transcripts independently and developed a codebook. Investigators met to discuss common themes and outcomes.

RESULTS

Participants received early education on patient interviewing and physical examination skills, health policy, and ultrasound. They noted their course experience was a productive way to gain insight into medical school and often cited it when applying for their chosen professional school. Although not a formal part of the course curriculum, many received guidance on the medical school application process, and some obtained letters of recommendation from physician facilitators. Participants emphasized the sense of belonging within the medical school community and affirmation of pursuing a health professional degree.

CONCLUSION

Participants found their experience to be meaningful and cited it as an influential factor in deciding to pursue a health professional degree. The course could be adopted by other institutions to enhance the variety of pre-health experiences for future medical students or health profession students.

Resilience's role in clinical belongingness and presenteeism of new nurses: A moderated mediation model

This study explored the mediating effect of resilience on clinical belongingness and presenteeism of new nurses. A total of 271 new nurses completed the Connor-Davidson Resilience Scale, Belongingness Scale-Clinical Placement Experience, and Stanford Presenteeism Scale. It was found that resilience correlated positively with clinical belongingness, while presenteeism was negatively correlated with resilience and clinical belongingness. The mediating effect of resilience on clinical belongingness and implicit absence accounted for 42% of the total effect value. Hence, new nurses' resilience plays an intermediary role between clinical belongingness and presenteeism. Nursing managers can develop interventions to reduce the sense of clinical absence by improving the resilience of new nurses.

Psychometric evaluation of the Persian version of the Sense of Belonging in Nursing School (SBNS): a quantitative and cross-sectional design

BACKGROUND

This study aimed to evaluate the psychometric indicators of the Persian version of the Sense of Belonging in Nursing School scale (SBNS).

METHODS

The study conducted in Shahroud and Semnan schools of nursing and midwifery in Iran examined nursing students using a cross-sectional approach by convenience sampling method from 3/6/2023 to 24/8/2023. To assess the SBNS scale, the forward-backward procedure was used to translate it into Persian. Face and content validity were evaluated, and exploratory and confirmatory factor analyses were conducted with sample sizes of 200 and 182, respectively. Reliability was assessed using Cronbach's alpha coefficient, MacDonald's omega, and intra-class correlation coefficient.

RESULTS

The exploratory factor analysis resulted in the exclusion of four items, leaving a final selection of 15 items. These items were categorized into three factors: classmates, clinical staff, and inclusive educational environment, which accounted for 49.16% of the overall variance. The confirmatory factor analysis indicated that the model was a good fit for the observed data, and the subscales had high internal consistency (Cronbach's alpha coefficient was 0.752 to 0.880) and stability (intra-class correlation coefficient was 0.889 to 0.968).

CONCLUSION

According to the results, it can be concluded that the Persian version of the SBNS scale demonstrates sufficient validity and reliability in assessing students' sense of belonging to the nursing school.

New nurses' turnover intention and clinical belonging, based on latent class analysis (LCA)

AIM

To identify potential categories of clinical belonging among new nurses and explore the relationship between different categories and turnover intention.

DESIGN

A cross sectional study.

METHOD

A cross sectional study was conducted among 348 new nurses from tertiary hospitals in Hainan and Guangdong provinces. A general data questionnaire, clinical belonging scale and turnover intention scale were used for examination. Further, the potential categories were used to analyse the categories of clinical belonging, and latent class analysis was utilized to analyse the relationship between different categories of clinical belonging and turnover intention.

RESULTS

The clinical sense of belonging of new nurses were divided into three groups namely C1, C2 and C3. The C1: poor clinical sense of belonging (8.7%), C2: moderate clinical sense of belonging (57.9%) and C3: rich clinical sense of belonging (33.4%). The risk of the turnover intention of new nurses with 'poor clinical sense of belonging' was 0.62 times that of new nurses with 'rich clinical sense of belonging' (OR = 0.62, p < 0.01), which was 0.24 times that of 'moderate clinical sense of belonging' (OR = 0.24, p < 0.01), the risk of the turnover intention of new nurses with 'moderate clinical sense of belonging' was 0.13 times that of new nurses with 'rich clinical sense of belonging'(OR = 0. 13, p < 0.01).

CONCLUSIONS

The results of our study revealed that in order to enhance the new nurses' sense of belonging, support was most crucial when they were first encountering difficulties. To reduce turnover intention, more structured learning opportunities are also required to maximize learning for newly graduated nurses with various nursing degrees.

PATIENT OR PUBLIC CONTRIBUTION

There are no patient or public contributions in this study.

The Sense of Belonging in the Context of Migration: Development and Trajectories Regarding Portuguese Migrants in Luxembourg

The sense of belonging can be defined as a highly subjective and dynamic feeling of acceptance, inclusion, and connectedness to a specific contextual entity. Perceiving belongingness to others is positively related to psychological well-being, happiness, or higher self-esteem. The present contribution examined how the sense of belonging to spatial, social, and cultural entities evolves over the migration process of Portuguese first-generation migrants and their second-generation offspring residing in Luxembourg. The current study drew on the qualitative content analysis of ten semi-structured interviews, carried out with ten Portuguese migrant family dyads (one parent and one adult child per dyad). The results affirmed that the sense of belonging showed to be a complex and multi-faceted concept and highly shaped by specific contexts. The initially unfamiliar Luxembourgish context became a familiar setting and even a "home" over time. While the older generation presented noticeable belongingness to Luxembourg as a homeland, their affiliation to the Luxembourgish community and culture remained rather low. Simultaneously, they preserved a high connectedness to the Portuguese culture as well as to fellow Portuguese migrants living in the Grand Duchy. The younger generation expressed a much more pronounced attachment to Luxembourg, since they perceived belongingness to the Luxembourgish spatial, social, and (multi)cultural milieu. In addition to this, a certain affiliation to the Portuguese culture and language could be discerned. Although some factors, which might have contributed to this evolution, could be identified in the present study, one can assume that there are significantly more that have not been addressed yet.

DEVELOPMENT AND PSYCHOMETRIC TESTING OF THE SENSE OF BELONGING IN NURSING SCHOOL SCALE

Background and Purpose: While sense of belonging is essential for human motivation, impaired belonging among nurses can impact the care and safety of patients. This article reports the development and psychometric testing of the Sense of Belonging in Nursing School (SBNS) scale to assess nursing students' sense of belonging in three different environments: Clinical, classroom, and among the student cohort. Method: Principal component exploratory factor analysis with varimax rotation was used to determine the construct validity on the 36-item SBNS scale with a sample of 110 undergraduate nursing students. Cronbach's alpha was used to determine the scale's internal consistency. Results: The scale was reduced to 19-items with high internal consistency (α = 0.914). Principal component analysis then identified four factors (sub-scales) with high internal consistency: Clinical staff (α = 0.904), clinical instructor (α = 0.926), classroom (α = 0.902), and classmates/cohort (α = 0.952). Conclusion: The SBNS scale is a reliable and valid tool to measure sense of belonging across three environments among nursing students. Further research is needed to determine the scale's predictive validity.

Male nursing students' experiences during prelicensure education: An integrative review

BACKGROUND

Males represent less than 10 % of the global nursing workforce. To increase the recruitment and representation of male nurses, their experiences in prelicensure nursing education must be understood.

OBJECTIVES

The purpose of this integrative review was to explore literature related to male nursing students' experiences during prelicensure education.

DESIGN

An integrative review of the literature was conducted using Whittemore and Knafl's methodology.

DATA SOURCES

Database searches of CINAHL, PubMed, ERIC, Emcare, and Scopus were conducted.

REVIEW METHODS

Database searches identified 237 articles for initial review. Titles, abstracts, and full-text articles were screened for relevance. Quality appraisal was evaluated using the Mixed Methods Appraisal Tool Version 2018. Data analysis was conducted using Conventional Content Analysis.

RESULTS

Twenty-two articles (19 qualitative, two quantitative, and one mixed-methods) were included in this review. The existing literature suggests that male nursing students have generally negative experiences during their prelicensure education due to external reactions from family, friends, peers, and healthcare providers to their choice of nursing as a profession; lack of male role models; extensive assistance with physical tasks in the clinical setting; exclusion in obstetrics clinical experiences; and female-gendered descriptions of nurses within the educational environment. Fostering new relationships was identified as a positive experience during prelicensure education.

CONCLUSIONS

Generally, male nursing students have negative experiences during their prelicensure education, with limited positive experiences. As such, nurse educators should implement strategies, such as avoiding gendered references when referring to the nurse, offering male mentorship when possible, and providing comparable clinical assignments to students regardless of gender, to improve male nursing students' experiences in prelicensure education and, consequently, increase the recruitment and retention of men into the nursing profession. Future research is needed to more comprehensively understand male nursing students' experiences during prelicensure education and the impact of teaching strategies on their experiences.

Cross-sectional Study of the Relationship between Experiences of Incivility from Staff Nurses and Undergraduate Nursing Students’ Sense of Belonging to the Nursing Profession

AIM

This study examined the frequency of incivility for undergraduate nursing students and the relationship between staff nurse incivility and nursing students' sense of belonging. Factors between program semester and students' body mass index (BMI) to staff nurse incivility and students' sense of belonging were assessed.

BACKGROUND

Sense of belonging enhances belonging development to the profession. However, no studies address the relationship between incivility and nursing students' sense of belonging.

METHODS

A cross-sectional design assessed the relationship between staff nurse incivility and undergraduate nursing students' sense of belonging to the nursing profession. An online survey was administered to 123 pre-licensure junior and senior undergraduate nursing students from February 1, 2021, to May 5, 2021. Correlation coefficient, descriptive statistics, Fisher r-to-z transformation, 95% confidence intervals were calculated.

RESULTS

Staff nurse incivility inversely correlated with undergraduate nursing students' sense of belonging (rs=-.358; p <.001). American Indian or Alaskan Native students reported the highest mean frequency of incivility (1.25 ± .421). There were no significant differences in correlations based on semester or BMI.

CONCLUSION

Staff nurse incivility is inversely associated with sense of belonging in students. Further research is needed to test interventions mitigating the effects of incivility on belonging.

Does the nursing curriculum influence feelings of gender-role conflict in a cohort of nursing degree male students?

It is estimated that more than 9% of the global nursing workforce is male and that this share will gradually rise over the next decade. Although there are some positive aspects of having a male nursing workforce, men in the profession still experience discriminatory behaviours and practices. Fortunately, this does not deter a number of men entering undergraduate degree programmes. The aim of this study was to understand the experiences of 14 male nursing students in their first year of the adult Bachelor of Nursing programme. Using the Inventory of Male Friendliness in Nursing Programs and the Gender Role Conflict Scale, this study found that the male students felt welcomed, supported and included into the nursing programme. In addition, they felt no overall gender-role conflict, although feelings of success and achievement caused some challenges. The results of this study suggest that the male students did not necessarily experience those inequitable behaviours and practices reported in the literature. It has been suggested that perhaps the reality of clinical practice may change the perception of nursing for male students. Therefore, implications for further research could include a longitudinal study to ascertain where the perceptions of the nursing programme change for the male nursing students over time.

Moral intelligence, clinical placement experience and professional behaviors among Iranian undergraduate nursing students in a baccalaureate nursing program: A descriptive correlational study

AIMS

This study was intended to examine the relationship of both moral intelligence (MI) and Clinical Placement Experience (CPE) with the level of nursing students' professional behaviors (PB).

BACKGROUND

The foundation of belief, belonging and ethical values develop PB as a meaningful attribute during the period students and caring for patients.

DESIGN

A descriptive correlational study was conducted.

METHODS

Descriptive data were derived from the Belongingness Scale-Clinical Placement Experience (BES-CPE), the Moral Intelligence Questionnaire (MIQ) and the Nursing Students Professional Behaviors Scale (NSPBS) including 200 students (response rate 94.5%).

RESULTS

We found a statistically strong positive correlation between NSPB, MI and CPE. The regression model accounted for 57.8% of the variance in NSPB; CPE and MI were significant explanatory variables of NSPB. Moreover, the non-employed dormitory students had a significant statistical difference in the scores of all three variables. Female students had significantly higher CPE and MI (p˂0.05).

CONCLUSIONS

According to our findings, preventive and mediation endeavors for nursing students can explicitly target their behavioral skills to reduce perceived rejection and improve morality. As a result, an optimal plan to improve the quality of professional training courses for students should be designed based on the comprehension of clinical belonging and moral intelligence.

Students' perceptions of belonging in the School of Nursing at a regional university in Australia

BACKGROUND

Attrition in pre-registration nursing degrees is a global issue. Students' perceptions of belonging is a factor that influences attrition.

OBJECTIVE

The objective of this study was to evaluate students' perception of belonging to a School of Nursing, as well as their intention to complete the pre-registration Bachelor of Nursing (BN) program following implementation of the Initiatives for Retention (IR) intervention.

DESIGN

A prospective cross-sectional survey of student nurses was undertaken using an online questionnaire.

SETTING

A large regional university in Australia.

PARTICIPANTS

Pre-registration nursing students.

METHODS

Perceptions of Belonging were evaluated using the 24-item Belonging questionnaire comprising three subscales. Data were analysed using SPSS version 25. Pearson's correlation, Student's t-tests and one way ANOVA were used to assess associations and differences in belonging scores and student demographics, study status and participation in the Initiatives for Retention (IR) intervention.

RESULTS

A total of 201 students responded to the voluntary questionnaire. The mean score for overall Belonging was 70.5 (maximum obtainable 96), mean Scores for University affiliation, University support and acceptance, and staff relations with students were 34.7, 24.1 and 11.8 respectively. Female students, those who were studying at the university for less than a year and those who participated in the IR intervention activities reported significantly higher University Belonging scores compared to their contemporaries. Logistic regression revealed that students studying the BN course for more than 3 years (OR: 0.43 95% CI 0.20-0.93, p = 0.031), and those employed (OR: 0.435, 95% CI 0.16-0.16, p = 0.022) were significant predictors of not attending the IR sessions. There were no significant differences in overall University Belonging scores based on other demographic characteristics and, study status. The majority of the students (84%) stated that they plan to continue and complete the BN program.

CONCLUSIONS

Measures designed to develop student involvement may positively contribute a successful relationship between the institution and the student, increasing the students' sense of belonging and decreasing attrition among student nurses.

PRACTICE IMPLICATIONS

Initiatives for Retention (IR) facilitate a greater sense of belonging in nursing students hence Schools of Nursing should consider embedding such strategies.

Us and them: The experience of international nursing students engaged in team based learning: A qualitative descriptive study

BACKGROUND

International students report multiple challenges adjusting to educational settings. Instructional strategies such as Team Based Learning (TBL), could provide international students with opportunities that promote academic success, language skills and social connectedness. However, little is known about international students' experience of TBL. The aim of this study was to explore culturally and linguistically diverse (CALD) students' experiences of TBL.

METHODS

This paper reports on a qualitative study that explored the experiences of 15 international students enrolled in an Australian university nursing program, where TBL is used.

RESULTS

Findings indicate that TBL promotes language proficiency and respectful intercultural connections. It also uncovered an unintentional benefit of TBL in interrupting racism towards international students from domestic students. However, it is not enough to rely on TBL to mitigate the impact of racial and cultural power dynamics in educational settings.

CONCLUSION

To improve international student experiences, educators must actively engage students in dialogue about privilege and structural racism as it relates to international students and other people of colour.

Psychology and learning: The role of the clinical learning environment

The clinical learning environment for the postgraduate education of physicians significantly influences the learning process and the outcomes of learning. Two critical aspects of the learning environment, when viewed through a psychology lens are (1) constructs from psychology relevant to learning, such as cognitive load theory and learner self-efficacy; and (2) psychological attributes of the context in which learning occurs such as psychological safety and "Just Culture". In this paper, we address selected psychological aspects of the clinical learning environment, with a particular focus on the establishment and sustainment of psychological safety in the clinical learning environment for physicians. Psychological safety is defined as individuals' perceptions that they can speak out in the learning or working context without consequences for their professional standing or risks to their status on work teams or groups. We close with seven critical strategies for use by educators, learners, health systems leaders, and other stakeholders to contribute to a clinical environment that optimizes learning. These dimensions can also provide avenues for future research to enhance the community's understanding of psychological constructs operating in the clinical learning environment.

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.

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.

Current Practices in Hosting Non-US Pharmacy Students at US Pharmacy Schools in Experiential Clerkships

Objective: To provide specific considerations for hosting non-U.S. pharmacy students at U.S.-based colleges/schools of pharmacy (C/SOP) for experiential clerkships and training. Findings: A literature review (2000-2016) in PubMed, Google Scholar and IPA databases was conducted using specific keywords. Recommendations and future directions for development of experiential rotations for non-U.S. students in U.S. experiential rotations are presented for both the home and host country. Summary articles and best practices across the disciplines, as well as expert opinion, were found across U.S. models for hosting non-U.S. students in advanced practice rotations in the medical disciplines. Consistent themes regarding legal agreements, acculturation, standardized calendars and social and safety considerations were considered for inclusion in the final document. Conclusion: Development of a successful experiential rotation/training for non-U.S. students requires consideration for well-developed objectives, qualified preceptors, multitude of legal and cultural considerations and recommendations for longevity and sustainability.

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.

Nursing students' satisfaction of the clinical learning environment: a research study

Background

The acquisition of quality clinical experience within a supportive and pedagogically adjusted clinical learning environment is a significant concern for educational institutions. The quality of clinical learning usually reflects the quality of the curriculum structure. The assessment of the clinical settings as learning environment is a significant concern within the contemporary nursing education. The nursing students’ satisfaction is considered as an important factor of such assessment, contributing to any potential reforms in order to optimize the learning activities and achievements within clinical settings.

The aim of the study was to investigate nursing students’ satisfaction of the clinical settings as learning environments.

Method

A quantitative descriptive, correlational design was used. A sample of 463 undergraduate nursing students from the three universities in Cyprus were participated. Data were collected using the Clinical Learning Environment, Supervision and Nurse Teacher (CLES + T).

Results

Nursing students were highly satisfied with the clinical learning environment and their satisfaction has been positively related to all clinical learning environment constructs namely the pedagogical atmosphere, the Ward Manager’s leadership style, the premises of Nursing in the ward, the supervisory relationship (mentor) and the role of the Nurse Teacher (p < 0.001). Students who had a named mentor reported more satisfied with the supervisory relationship. The frequency of meetings among the students and the mentors increased the students’ satisfaction with the clinical learning environment. It was also revealed that 1st year students were found to be more satisfied than the students in other years.

Conclusion

The supervisory relationship was evaluated by the students as the most influential factor in their satisfaction with the clinical learning environment. Student’s acceptance within the nursing team and a well-documented individual nursing care is also related with students’ satisfaction. The pedagogical atmosphere is considered pivotal, with reference to students’ learning activities and competent development within the clinical setting. Therefore, satisfaction could be used as an important contributing factor towards the development of clinical learning environments in order to satisfy the needs and expectations of students. The value of the development of an organized mentorship system is illustrated in the study.

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.

Psychometric Testing of the Greek Version of the Clinical Learning Environment-Teacher (CLES+T)

Clinical practice is an important part of nursing education, and robust instruments are required to evaluate the effectiveness of the hospital setting as a learning environment. The study aim is the psychometric test of the Clinical Learning Environment+Teacher (CLES+T) scale-Greek version. 463 students practicing in acute care hospitals participated in the study. The reliability of the instrument was estimated with Cronbach's alpha coefficients. The construct validity was evaluated using exploratory factor analysis (EFA) with Varimax rotation. Convergent validity was examined by measuring the bivariate correlations between the scale/subscales. Content, validity and semantic equivalence were examined through reviews by a panel of experts. The total scale showed high internal consistency (α=0.95). EFA was identical to the original scale, had eigen values larger than one and explained a total of 67.4% of the variance. The factor with the highest eigen value and the largest percentage of variance explained was "supervisory relationship", with an original eigenvalue of 13.1 (6.8 after Varimax rotation) and an explanation of around 38% of the variance (or 20% after rotation). Convergent validity was examined by measuring the bivariate correlations between the scale and a question that measured the general satisfaction. The Greek version of the CLES+T is a valid and reliable instrument that can be used to examine students' perceptions of the clinical learning environment.

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.

Undergraduate student nurses' perceptions of two practice learning models: a focus group study

BACKGROUND

Phase 1 of this study examined student, mentor and clinical manager's perceptions of a 'Hub and Spoke' practice learning model in year 1 of an undergraduate nursing programme. Findings from Phase 1 suggested that the model had significant educational merit in orientating students to clinical learning and emphasising the primacy of the mentor relationship in developing and supporting students. Following the students through year 2 of their programme, wherein they experienced a 'rotational' practice learning model, which provided an opportunity to explore student perceptions of both models.

AIMS

To explore undergraduate nurses' perceptions of two experienced practice learning models: hub and spoke model, and the classical rotational model. In a previous study the hub and spoke model appeared to develop 1st year students' sense of belongingness, continuity and quality of practice learning, there for it was important to understand what students reported about these issues when recounting their 2nd year experience in the clinical setting that was organised according to a classical rotational model.

DESIGN

Qualitative approach utilising focus groups.

PARTICIPANTS

10 under-graduate student nurses at the end of 2nd year.

METHODS

Focus group interviews.

RESULTS

Students responded in ways that indicate they believed the experiences of year 1 had raised their faith in their ability to cope with the practice learning and educational demands of nursing. They saw themselves as being better prepared for year 2 as a result of their exposure to hubs and spokes. The study has identified traits of resilience, continued belongingness and self-confidence in orientation to learning in clinical practice in hub and spoke experienced students.

CONCLUSIONS

The student nurses found the hub and spoke model valid in 1st year, whilst stating that for 2nd year the rotational model can be valid. This supports earlier findings that student nurses require a structured and supportive 1st year learning environment to enable development of resilience for subsequent years.

How therapeutic communities work: specific factors related to positive outcome

BACKGROUND

Therapeutic communities (TCs) are becoming increasingly widespread as a form of treatment for entrenched mental health problems, particularly addictions and personality disorders, and are equally used in educational, prison and learning disability settings. Despite growing evidence for their effectiveness, little research has been conducted to establish how TCs work to produce positive outcomes. We hypothesize that there are two specific factors that in combination contribute to TC effectiveness: the promotion of a sense of belongingness and the capacity for responsible agency. Although both factors are found in other therapeutic approaches and are important to the psychosocial aspects of psychiatric care more generally, we argue that their combination, extent and emphasis are unique to TCs.

MATERIAL

Drawing on social and experimental psychology, we: (1) review research on a sense of belongingness and the capacity for responsible agency; (2) establish the mechanisms by which TCs appear to promote them; (3) draw lessons for TC practice; and (4) suggest why they may contribute to positive outcome.

DISCUSSION

A sense of belongingness is correlated with improved self-esteem and overall well-being. The capacity for responsible agency is central to behavioural change. TCs are typically used in fields where positive outcome requires both personal growth and behavioural change. We suggest that TCs are uniquely placed to demand such growth and change of their members because the sense of belongingness engendered by TC methods protects against the risks engendered by this demand.

CONCLUSION

Empirically informed, evidence-driven research is necessary to understand how TCs work and how TC practice can be improved. This understanding may offer lessons for the improvement of psychosocial aspects of psychiatric care more generally.

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.

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

BACKGROUND

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

OBJECTIVES

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

DESIGN

Multiple case study design.

SETTING & PARTICIPANTS

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

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.

Understanding and enhancing the learning experiences of culturally and linguistically diverse nursing students in an Australian bachelor of nursing program

The growth in numbers of culturally and linguistically diverse students entering nursing programs in Australia presents challenges for academic and clinical staff, and most importantly the students themselves. In this paper we present the findings from a pilot study designed to explore these issues and to develop strategies to address them. This study used a qualitative explorative approach to gain rich in-depth data. Eleven culturally and linguistically diverse students, three clinical facilitators, and four academic staff participated in focus group interviews. Four major themes emerged: level of English language competence, feelings of isolation, limited opportunities for learning, and inadequate university support. The issues we identified led to a meaningful discussion of the political, financial, social and intercultural context that they are entrapped in. This paper provides educators, clinicians, policy makers and researchers with an insight where and how they commence to break the trap and highlights, the need for further research into the perspectives of Australian students' who study and socialise with their international peers.