Nursing students’ experiences of clinical placement in community settings: A qualitative study

A qualitative study of the value of simulation-based training for nursing students in primary care

BACKGROUND

Clinical placement is an essential component of nursing education, providing students with the opportunity to apply theoretical knowledge to practice. However, challenges such as lack of supervision and passive involvement in tasks can hinder the learning experience. Supplementing clinical placement with simulation-based training (SBT) has been explored as a potential solution, though this approach has been underexplored within primary care. This study aimed to explore the educational value of a supplemental SBT course for nursing students during primary care placement, as well as the adaption of this approach to a primary care setting.

METHODS

A qualitative descriptive study was conducted at a medical education and simulation academy in Denmark. Sixth-semester nursing students on placement in primary care were invited to participate. The intervention consisted of a three-day simulation course covering core nursing competencies and common clinical conditions encountered within primary care. Simulation adopted a standardised patient approach. Data was collected using focus group interviews, which was analysed using inductive thematic analysis.

RESULTS

Thirty-one nursing students participated in the study. Seven themes emerged from the analysis, including perceptions, educational value, simulation adjustments to primary care, educators' competencies, learning needs within primary care, challenges of clinical placement and career guidance. Generally, participants perceived the intervention positively, appreciating its relevance to their clinical placement and its educational impact in this context. Participants also provided insights into the adaptation of SBT to a primary care setting, as well as nursing students' learning needs within this context.

CONCLUSION

The findings indicate that the intervention had a positive impact on participant competencies within this context and enhanced their clinical practice within primary care. Furthermore, the results inform educators on how to effectively employ primary care-related SBT. Overall, this study supports the need for an increased application of SBT within primary care.

TRIAL REGISTRATION

Not relevant.

Mapping interaction quality for nursing and medical students in primary care placement in municipal emergency care units: a systematic observational study

Introduction

Primary care placement for nursing and medical students is vital for developing the competence to accommodate the increasing number of patients with multimorbid and complex conditions. Prior studies have suggested that interaction quality in primary care placement empowers learning. However, research mapping interaction quality in primary care placements in municipal emergency care units is lacking. This study aimed to systematically map interaction quality for nursing and medical students in primary care placement in two municipal emergency care units.

Materials and methods

This study adopted a systematic descriptive observational design. Systematic observations (n = 201 cycles) of eight nursing students (n = 103 cycles) and six medical students (n = 98 cycles) were used to map interaction quality across six learning situations between March and May 2019. Observations were coded using the Classroom Assessment Scoring System-Secondary (CLASS-S). Data were analyzed using descriptive statistics and Spearman correlations.

Results

Interaction quality is described in three domains: (I) emotional support, (II) framework for learning, and (III) instructional support, and the overall measure, student engagement. The results indicated middle-quality interactions in the emotional and instructional support domains and high quality in the framework for learning domain and student engagement. Correlations exhibited similar patterns and ranged from non-significant to strong correlations.

Conclusion

The interaction qualities indicated a generally positive and supportive learning environment contributing to nursing and medical students' learning and active participation in work tasks related to their professional roles. Thus, this new form for primary care placement for nursing and medical students in the municipal emergency care units was found to be a positive learning arena. These results may enhance nursing and medical education programs in countries with similar health services and education. Health education, supervisors, peers, and others contributing to students' learning should recognize which interaction qualities may affect learning and how to improve quality, thus affecting supervisors' approach to training students. While the CLASS-S showed potential for mapping interaction qualities for nursing and medical students in primary care placement in municipal emergency care units, further studies are needed to validate the CLASS-S for use in clinical placement settings.

Nursing students' perceptions on community care and placement preference in Saudi Arabian universities: A multicenter cross-sectional study

BACKGROUND

There is an increasing shortage of highly educated community nurses; only a small number of nursing students choose to work in the community.

OBJECTIVES

To understand the perception among nursing students in Saudi Arabia about working in the community and where they intend to pursue their careers.

DESIGN

A quantitative cross-sectional design.

SETTINGS AND PARTICIPANTS

A convenience sample of undergraduate students enrolled in their first to final years of a bachelor's degree program at three Saudi Arabian universities.

METHODS

Data were collected from September-December 2022 using the 'Scale on Community Care Perceptions', which included demographic questions and measures reflecting their impressions of a community care placement, a community care career, and their current placement preferences.

RESULTS

In total, 439 students completed the online questionnaire. Nursing students' community care feelings (affective component), expectations, and regards as a future profession were moderately positive with a mean of 6.68 (1-10 scale; negative-positive perceptions). Regarding placement preference, many students chose general hospitals (N = 212, 48.30 %); a small number chose community care (N = 77, 17.54 %). The positive choice of respondents was influenced by the various technical nursing skills required (N = 212, 10.6 %), enjoyable relationships with patients (N = 211, 10.5 %), and many opportunities for advancement (N = 169, 8.4 %). Furthermore, students' placement preferences were significantly predicted by their expectations of placement and future professions in community care (F = 95.24, p < 0.01, R2 = 0.30). A significant difference was also found among their preferences in terms of the level of education and the experience of family and friends working in the community (p < 0.01).

CONCLUSION

Community care is an undervalued career choice among nursing students in Saudi Arabia. To bolster nursing students to prefer this career path, nursing schools, in coordination with local authorities, must formulate and implement a clearly defined career development plan that allows them to fully immerse themselves in community care activities.

Assessing the quality of nursing clinical placement: A quantitative cross-sectional study

AIM

To evaluate the quality of nursing clinical placement among nursing students.

DESIGN

This is a descriptive cross-sectional study.

METHODS

Two hundred eighty two nursing student completed self-administered, online questionnaires. The questionnaire assessed participants' socio-demographic data, and the quality of their clinical placement.

RESULTS

The students had a high mean score for the overall satisfaction of their clinical training placement with high mean score for the item of "patient safety was fundamental to the work of the units" and the item of "I anticipate being able to apply my learning from this placement," while the lowest mean score was related to "This placement was a good learning environment" and "Staff were willing to work with students." Patient or Public Contribution: Quality of clinical placement is critical for improving the everyday quality of care for patients who are in desperate need of caregivers with professional knowledge and skills.

A mixed methods study using case studies prepared by nursing students as a clinical practice evaluation tool

AIM

To identify the presence of variability in the evaluation of case studies prepared by nursing students during their primary care rotations based on the existing evaluation rubric. To explore the difficulties experienced by link lecturers and students in preparing and evaluating case studies.

DESIGN

A mixed methods study.

METHODS

The scores for the rubric items and the final grades for the case studies were collected from a sample of 132 cases. Qualitative information was collected by conducting open-ended interviews with lecturers and a focus group session with students.

RESULTS

Statistically significant differences were identified between the lecturers' mean final grades [F(5.136) = 3.984, p = 0.002] and a variety of items in the evaluation rubric (p < 0.05). In addition, effect sizes [η2 (≈0.14)] of considerable magnitude were found. Two themes emerged from the qualitative data: (1). the challenge of preparing the case studies and (2). the variable nature of the evaluations.

Experiences of nursing students during their mental health clinical training at a general hospital in Namibia

BACKGROUND

 Clinical training is important because it constitutes more than half of the formal courses in nursing education. Accordingly, it is important for institutions of higher learning to continually explore the experiences of nursing students during their clinical placement. These experiences can be used to promote a positive clinical learning environment for students. However, the experiences of nursing students during their mental health clinical training in Namibia have not been extensively researched.

OBJECTIVES

 The aim of this study was to explore and describe the experiences of nursing students during their mental health clinical training at a general hospital in Namibia.

METHOD

 A qualitative, exploratory, descriptive and contextual research design was followed as the basis for conducting the study. A sample of 15 nursing students was conveniently selected from the target population of 73 nursing students. This sample size was determined by the saturation of data as reflected in repeating themes.

RESULTS

 The following three themes emerged: collating theory and mental health practice experiences, facing challenges in clinical placements, and recommendations to ensure effective learning about mental health.

CONCLUSION

 The use of a general hospital for clinical placements within an undergraduate nurse training course led to some concerns regarding the relevance and appropriateness of such experience within a nursing programme.Contribution: The findings have important implications for the training of undergraduate nursing students in general hospitals. It can be utilised to develop strategies to improve positive clinical practice placement and develop clinical skills for undergraduate nursing students in general hospitals.

A scoping review of clinical skill development of preregistration registered nurses in Australia and five other English-speaking countries

AIM

The aim of this scoping review is to synthesise current evidence around the clinical skill development of preregistration registered nurses (RNs) in Australia, United Kingdom (UK), Ireland, United States (US), Canada and New Zealand, to inform nurse education, policy and clinical practice.

BACKGROUND

Nursing is a practical profession, and registered nurses require specific skills, knowledge and attributes in order to care for patients safely. The context for health care delivery is shifting, and the education of nurses must adapt to effectively equip the registered nurse of the future.

DESIGN

A scoping review was conducted of clinical skill development in preregistration nurses. CINAHL Plus, MEDLINE, Health Source (Nursing/Academic edition) and Scopus were searched. Included studies were primary Australian studies and international literature reviews, which focussed on preregistration nursing education. Papers were written in the English language and focussed on clinical skill development. Results were synthesised narratively. The review is reported here in accordance with the Preferred Reporting Items for Systematic Review and Meta-analyses Scoping Review extension (PRISMA-ScR) guidelines.

RESULTS

One hundred fifty-five Australia studies and 89 international reviews were included in the review. Six key themes were identified, namely clinical skills, approaches to teaching and learning, interprofessional education, assessment of learning, clinical placement and simulation.

CONCLUSION

There is substantial variation in strategies and programmes to facilitate clinical skill development both within Australia and internationally, indicating a genuine shift away from traditional didactic pedagogy. New graduate registered nurses were expected to be "work-ready," albeit at a novice level, when they enter the workplace. Future research should consider measures of impact on actual clinical practice and focus on developing work-ready graduates for the range of clinical settings in which they may practice. Educators, policymakers and educational institutions can use these findings to inform curriculum developments to ensure that clinical skill development is evidence-based.

Nursing students' experiences of service-learning at community and hospital pharmacies in Belize: Pedagogical implications for nursing pharmacology

OBJECTIVES

Many students seem to find pharmacology learning very challenging due to the complexity and variety of drugs they have to study. The number of drugs the students have to learn, the duration of time to learn the medications, and the evolving nature of diseases demanded learning beyond the classroom walls. This study explored and described nursing students' experiences in community and hospital-based pharmacy practice sites during their service-learning and its implications for pharmacology pedagogical practices.

METHODS

Kolb's learning theory provided the framework to explore nursing students' 48-hour service-learning experiences at community/hospital-based pharmacies in Belize and its implications for pharmacology pedagogy. The study utilized two qualitative approaches, reflective journals and focus group interviews, to collect data from 46 second-year nursing students. NVivo software and coding schemes were employed to analyze the data from the interviews and reflective journals.

RESULTS

Students reported learning medications, integrating classroom pharmacological knowledge at pharmacy practice sites, acquiring and enhancing communication skills, interpreting prescriptions, dispensing medications, drug calculations, taking inventory, doing vital signs, and patient education. In addition, students reported experiencing inter-professional relationships as healthcare team members. Anxiety was a major challenge experienced by many students at the beginning of the service-learning experience.

CONCLUSIONS

This study highlights the importance of experiential learning of pharmacology amongst second year nursing students, offering the opportunity to inform and support pharmacotherapeutics educators in designing strategies for more effective teaching of medications to nursing students. It also supports the addition of pharmacy placements to the nursing curriculum' as it shows that nursing students can learn medications, skills, and teamwork from experiential pharmacy site posting. Combining classroom instruction with pharmacy experiential service learning might be an effective complement for teaching nursing pharmacology.

Nursing students' experience of incivility behaviours and its correlation with their nursing professional values: A cross-sectional descriptive study

AIMS

The purpose of this study was to determine the relationship between experienced incivility behaviours and professional values in the clinical setting and also the factors influencing incivility and professional values.

DESIGN

Cross-sectional descriptive study.

METHODS

Data gathering tools used in the study includes demographic characteristics, incivility behaviour and nursing professional values. Data were analysed using IBM SPSS version 21.

RESULTS

The findings showed that incivility behaviours had a statistically significant negative correlation with professional values (r = -.150, p = .003), so that the level of incivility behaviours experienced by students was low (1.76 out of 5). This was while the level of professional values was moderate to high among students (3.72 out of 5). Due to the negative and statistically significant correlation between incivility behaviours experienced by students and nursing professional values, it is necessary that the officials of teaching hospitals inform nurses about incivility behaviours. Considering the negative and statistically significant correlation, it can be concluded that the reduction in nurses' incivility behaviours as patterns of the nursing profession causes nursing students to better acquire and internalize nursing professional values in the clinical setting. Nurse educators should also try to communicate with nursing administrators to exchange information about nurses' civil and incivility behaviours perceived by students.

The effect of a more community-oriented curriculum on nursing students' intervention choice in community care: A quasi-experimental cohort study

AIM

The aim of this study is to investigate the effect of a more 'community-oriented' baccalaureate nursing curriculum on students' intervention choice in community care.

BACKGROUND

Following a healthcare shift with increased chronic diseases in an ageing patient population receiving care at home, nursing education is revising its curricula with new themes (e.g., self-management) on community care. Although it seems obvious that students incorporate these themes in their nursing care interventions, this is unclear. This study investigates the effect of a redesigned curriculum on students' care intervention choice in community nursing.

DESIGN

A quasi-experimental quantitative study.

METHODS

This study with an historic control group (n = 328; study cohorts graduating in 2016 and 2017; response rate 83 %) and an intervention group n = 152; graduating in 2018; response rate 80 %) was performed at a University of Applied Sciences in the Netherlands. The intervention group experienced a curriculum-redesign containing five new themes related to community care (e.g., enhancing self-management, collaboration with the patients' social network, shared decision making, using health technology and care allocation). The primary outcome 'intervention choice in community nursing' was assessed with a specially developed vignette instrument 'Assessment of Intervention choice in Community Nursing' (AICN). Through multiple regression analyses we investigated the effect of the curriculum-redesign on students' intervention choice (more 'traditional' interventions versus interventions related to the five new themes). The control and intervention groups were compared on the number of interventions per theme and on the number of students choosing a theme, with a chi-square or T-test.

RESULTS

Students who studied under the more community-oriented curriculum chose interventions related to the new themes significantly more often, F(1461) = 14.827, p = <0.001, R² = .031. However, more traditional interventions are still favourite (although less in the intervention group): 74.5 % of the chosen interventions in the historic control group had no relation with the new curriculum-themes, vs. 71.3 % in the intervention group; p = .055).

CONCLUSIONS

Students who experienced a more 'community-oriented' curriculum were more likely, albeit to a limited extent, to choose the new community care themes in their caregiving. Seeing this shift in choices as a step in the right direction, it can be expected that the community care field in the longer term will benefit from these better skilled graduates.

Pediatric practicums in undergraduate nursing programs: an integrative review

BACKGROUND

Practicum Placements are the signature andragogy used in undergraduate nursing programs to bring about knowledge consolidation. Little is known, however, about the types of pediatric practicum placements utilized by nursing programs to provide practical learning opportunities in child health to their students. The purpose of this integrative review is to identify and appraise existing literature on practical pediatric practices in undergraduate nursing education.

METHOD

Searches were conducted using the main relevant databases and search engines. Of the numerous articles retrieved, screened, and reviewed, 15 met the inclusion and exclusion criteria. Results were then analyzed using thematic analysis.

RESULTS

Two overarching themes were identified: (1) Adaptation, and (2) Learning.

CONCLUSION

Findings revealed that most nursing programs utilize alternative placement sites to meet the learning need of their students. These sites provided students with the opportunities to care for children and adolescents, and engage in a variety of health promotion and teaching activities.

Effect of community-based education on undergraduate nursing students' skills: a systematic review

Background

Community-based education, as an effective approach to strengthen nurses’ skills in response to society’s problems and needs has increased in nursing education programs. The aim of this study was to review the effect of community-based education on nursing students’ skills.

Methods

For this systematic review, ProQuest, EMBASE, Scopus, PubMed/ MEDLINE, Cochran Library, Web of Science, CINAHL and Google Scholar were searched up to February 2021. The methodological quality of the studies was assessed using the Mixed Methods Appraisal Tool (MMAT). Seventeen studies were included in this systematic review. Inclusion criteria included articles published in English and were original articles.

Results

In all studies, undergraduate nursing students’ skills were improved by participation in a community-based education program. Community-based education enhances professional skills, communication skills, self-confidence, knowledge and awareness, and critical thinking skills and teamwork skills in undergraduate nursing students.

Conclusions

Community-based education should be used as an effective and practical method of training capable nurses to meet the changing needs of society, to improve nurses ‘skills and empower them to address problems in society.

Undergraduate student nurses' experiences of their community placements

BACKGROUND

Community nursing placements play an increasingly important part in the undergraduate nursing students learning experience as a greater proportion of health care delivery is set to migrate to community care settings. Therefore, nursing education programmes and health services must ensure that student nurses are exposed to high quality community placements that provide suitable learning experiences for students to acquire the skills and knowledge required for the health service of the future.

OBJECTIVES

This qualitative evidence synthesis examines undergraduate nursing students' experiences of community nursing placements from 1996 to date.

DESIGN

Qualitative Evidence Synthesis, Thematic synthesis.

DATA SOURCES

CINHAL, EMBASE, ProQuest, Medline, Embase, Scopus, Psycinfo.

REVIEW METHODS

A systematic search across electronic databases was carried out to identify all available existing evidence relevant to the search question. Data was extracted and synthesised through thematic synthesis to identify and interpret emerging themes.

RESULTS

Six qualitative studies were included in the data, from these three themes were identified. The first of these highlighted the important influence of the community nursing teams and mentor on the students' placement experience. The second theme highlights the students' professional development as a result of their community placements and finally the third theme explores the students' perceptions of the essence of caring in the community.

CONCLUSION

The community provides valuable learning experiences of nursing from an alternative perspective, enhancing professional development and understanding of the nurse patient relationship. Mentorship and inclusion in teams are key factors that influence students' experiences and this working environment is useful for teaching about holistic care that is person and family centered. Role modeling is enhanced by the pace and proximity of the mentoring relationship.

Co-developing and implementing a community nursing simulated learning resource for undergraduate nursing students

Policy agendas across the developed world privilege systems transformation, notably shifting the balance of service provision from hospital to community settings. Primary and community health services have pivotal roles in the United Kingdom's longstanding policy ambition of healthcare services transformation, and it is imperative that undergraduate nursing students comprehend community settings as valuable learning environments, places of care and community nurses' roles therein. However, limited community placement learning opportunities means nursing students may be inadequately prepared to work in community settings at the point of initial registration. High fidelity simulated learning is well established within undergraduate nursing curricula. Currently, this learning approach predominantly focuses on acute and secondary care nursing and takes place in simulation centres. Within undergraduate nursing curricula there is limited evidence to support that community-based simulation is utilised with the result that students may struggle to recognise the value of learning opportunities in the community environment. This underpins the rationale for the development of this educational initiative which reflects current health policy agenda of care being provided closer to home. In addition, the new pre-registration 'Future nurse: Standards of proficiencies' (NMC, 2019) acknowledge that registered nurses need to be able to care for people in their own home and in the community setting. This paper describes the co-development and implementation of a pilot, community nursing focused, simulated learning resource within an undergraduate adult field nursing programme in Wales, UK. TWEETABLE ABSTRACT: How one university co-developed and implemented a community focused simulation resource for undergraduate nursing students.

Nursing degree students' clinical placement experiences in Australia: A survey design

AIM

This study aimed to evaluate Australian nursing students' views of placements at seven tertiary education institutions with the use of the Placement Evaluation Tool (PET).

BACKGROUND

Clinical placements are a core element of healthcare education programs around the world (Chuan and Barnett, 2012) with undergraduate nursing students required to complete a prescribed number of hours as part of their degree. The quality of nursing clinical placements varies with a range of positive and negative learning experiences.

DESIGN

A survey design was used with a contemporary survey tool- the Placement Evaluation Tool (PET). Using Qualtrics software (Qualtrics, 2005) the on-line survey was distributed to approximately 6265 undergraduate nursing students at six Australian universities and one Technical and Further Education (TAFE) college where Bachelor of Nursing degree students were enrolled. Three Australian States were covered. Sites were selected where a project team member was employed.

METHODS

A total of 1263 nursing students completed the Placement Evaluation Tool (PET) - 19 items (rated 1-5), one global rating (rated 1-10) - following placement in three Australian States (July 2019-February 2020). Most - 618 (48.9%) completed a placement in acute care with placements positively rated overall.

RESULTS

The total PET mean score was 78.3% with 29.8% being 'extremely satisfied' (10 out of 10 - Item 20). However, 11.0% were dissatisfied with global ratings of four or less, whilst ratings between States differed significantly (p = <0.001). One third of respondents answered a free text statement relating to placement experiences, with significantly more comments from older students (p = <0.001) and from those with ratings in the lower range (p = <0.001). Three core themes emerged: 1. Staff Attitudes to Students, 2. Environment and 3. Lifestyle.

CONCLUSIONS

Whilst students' clinical experiences in Australia tend to be positive a minority reported exposure to negative staff attitudes, in unsafe environments, with lifestyle detriments. Further work is required to understand and enhance student experiences.

A Blueprint for Becoming a Successful Clinical Nursing Professor, Promoting Health and Wellness in the Clinical Environment to Produce Emerging Nurse Leaders

Clinical professors are a particularly important determinant of student success in becoming a proficient nurse. The clinical professor is responsible for helping students apply didactic knowledge to clinical skills. This article discusses strategies clinical professors can use to maximize undergraduate nursing students' skills and competencies and to raise awareness of healthy behaviors affecting patient care. Applying effective and fun strategies can help students decrease anxiety, apply critical thinking, develop autonomy, and learn time management. These applied strategies help students develop delegation skills required to be professional, competent nurses, while promoting health and well-being.

Students' Perspectives on Learning Practical Nursing Skills: A Focus Group Study in Norway

Practical nursing skills are complex and involve technical, theoretical, and practical aspects, caring perspectives adjusted to both patient and circumstances, as well as ethical and moral considerations. Patients' length of stay in hospitals is decreasing, and more advanced patient treatment is conducted in primary healthcare settings. Hence, education and nursing skills need adjustment in line with the rapidly evolving field of practice. Studies emphasize a need to uncover whether the technical aspect of nursing skills, in general, is challenging in students' learning. The aim of this study was to explore students' perspectives on practical nursing skills and how they can best learn these. Three focus group interviews were conducted with registered nurse students and intellectual disability nurse students in their last semester (n = 11). Conventional, inductive content analysis in line with recommendations from Hsieh and Shannon was used to analyze the data. Two main categories with subcategories were identified: (1) the content of practical skills, with subcategories (a) human-to-human relations, (b) organizational competence, and (c) technical mastering and (2) building competence, with subcategories (a) need for supervision, (b) planning the learning situations, and (c) relevance for practice. Students experienced that practical skills did not only include technical aspects but also the ability to establish a relationship to the patient and to organize their working day. Supervising was assumed as essential both when training in the simulation center and in clinical placement, as well as planning of the training, respectively. Students experienced that some skills learned in the university college were less relevant in clinical practice and that certain skills were difficult to perform in practice due to the type of clinical placement. Hence, there is a need to review the approach to and content of practical nursing skills' learning in healthcare undergraduate programs, to prepare students for clinical practice, and to ensure that they build the competence needed in healthcare services.

Health TAPESTRY: Exploring the Potential of a Nursing Student Placement Within a Primary Care Intervention for Community-Dwelling Older Adults

The increasing prevalence of chronic diseases in aging places demands on primary care. Nurses are the major nonphysician primary care workforce. Baccalaureate nursing programs should expose students to primary care and older adults to support these demands and help recruit new graduates to this setting. However, many baccalaureate nursing programs focus on acute care and placements aimed at older adults are viewed negatively. To address these curriculum challenges, third-year Canadian baccalaureate nursing students were placed in an innovative primary care program—Health TAPESTRY—for community-dwelling older adults. Health TAPESTRY involves an interprofessional primary care team, trained lay volunteers conducting home visits, system navigation, and an online software application. The goal of this study was to explore third-year baccalaureate nursing students’ perceptions of this unique clinical primary care placement. This qualitative descriptive study explored students’ perceptions of this placement’s strengths, weaknesses, opportunities, threats (SWOT), and outcomes. Nursing students participated in focus groups (n = 14) or an interview (n = 1) and five completed narrative summaries following visits. Qualitative content analysis was supported by NVivo 10. Strengths of the clinical placement included training for the intervention; new insights about older adults; and experience with home visiting, interprofessional team functions, and community resources. Weaknesses included limited exposure to older adult clients, lack of role clarity, lack of registered nurse role models, and technology challenges. Opportunities included more exposure to primary care, interprofessional teams, and community resources. No threats were described. Nursing students’ clinical experiences can be enhanced through engagement in innovative primary care programs. Adequate exposure to clients, including older adults; interprofessional teams; mentoring by registered nurses or advanced practice nurse preceptors; and role clarity for students in the primary care team should be considered in supporting baccalaureate nursing students in primary care clinical placements.

Embedding public health advocacy into the role of school-based nurses: addressing the health inequities confronted by vulnerable Australian children and adolescent populations

There has been a growth in Australian school-based nurses to address the inequities confronted by vulnerable students and school populations. Failure to address inequities can be evidenced in intergenerational poverty, poorer health and educational attainment and diminished life opportunities. School-based nurses are ideally located to advocate for public health policies and programs that address social determinants that detrimentally affect the health of school populations. However, school-based nurses can confront professional and speciality challenges in extending their efforts beyond individual student advocacy to effect change at the school population level. Guidance is required to redress this situation. This paper describes public health advocacy, the professional and speciality advocacy roles of school-based nurses and the barriers they confront in advocating for the health of school populations and strategies that can be used by key stakeholders to enhance school-based nursing public health advocacy efforts. School-based nurses who are competent, enabled and supported public health advocates are required if we are to achieve substantial and sustained health equity and social justice outcomes for vulnerable school populations.

Factors that influence Australian early career nurse employment outcomes and settings: A prospective cohort study

AIM

To identify the factors influencing employment outcomes and settings for early career nurses.

BACKGROUND

A shortage of nurses attracted to work in out-of-hospital settings exists. Despite this, not all nursing graduates can secure work as a nurse. Information on the factors that impact wider graduate employment is available. However, a nursing perspective is missing, especially for hard to recruit to areas.

METHODS

A prospective cohort study was conducted. Participants were 293 final-year undergraduate nursing students, recruited from two universities. Data were collected over 12 months, commencing November 2016.

RESULTS

English as a first language was the greatest predictor of employment for graduates. Previous health care experience and workplace preferences predicted employment in the out-of-hospital setting.

CONCLUSIONS

Misalignment between English language requirements and industry expectations about language may lead to bias in recruitment of graduate nurses with English as their second language. Recruitment to out-of-hospital settings may be promoted by having health care experience and targeting those with a preference.

IMPLICATIONS FOR NURSING MANAGEMENT

Reviewing current employment policies to ensure they reflect the need for cultural diversity in the nursing workforce is critical. Additionally, research that aims to understand how preferences for out-of-hospital settings are developed will help target graduate employment strategies.

How nursing students' placement preferences and perceptions of community care develop in a more 'community-oriented' curriculum: a longitudinal cohort study

BACKGROUND

Extramuralisation in healthcare has influenced medical and nursing curricula internationally with the incorporation of themes related to primary/ community care. Despite this, students do not easily change their career preferences. The hospital is still favourite, leading to labour market shortages in extramural care. This study investigates how baccalaureate nursing students' perceptions of community care and placement preferences develop over time in a more 'community-care-oriented' curriculum, to gain insights on which curriculum elements potentially influence career choices.

METHODS

A nursing student cohort of a University of Applied Sciences in the Netherlands (n = 273) underwent a new four-year curriculum containing extended elements of community care. The primary outcome was assessed with the Scale on Community Care Perceptions (SCOPE). Data were collected each year of study. Descriptive statistics were used to investigate students' placement preferences and perceptions, and linear mixed model techniques (LMMs) for measuring how students' perceptions develop over time. Patterns of placement preferences at individual level were visualised.

RESULTS

Students' perceptions of community care, as measured with SCOPE, show a slight decrease between year 1 and 4, while items mutually differ substantially. In contrast, the preference of community care for a placement increases from 2.6% in year 1 tot 8.2% in year 4. The hospital is favourite in year 1 (79.8%), and remains most popular. At individual level, students often change placement preferences, although a preference for the hospital is more consistent. The LMMs indicates that, at the four time-points, the estimated marginal means of students' perceptions fluctuate between 6 and 7 (range 1-10). A placement in community care did not positively influence students' perceptions, and an intensive 1 week theoretical programme was only temporarily influential.

CONCLUSIONS

Although interest for placement in community care increased substantially, it was not clear which curriculum elements stimulated this, nor did the curriculum positively influence students' perceptions. As most students do not look forward to the high responsibility of the field, other curricula with educational tracks for more mature students/ nurses with a vocational training may be an alternative contribution to solving the labour market problems in community care.

A cross-sectional study on preferred employment settings of final-year nursing students in Israel

BACKGROUND

Despite the growing demand for community nurses, their number remains relatively low. We examined perceptions of final-year nursing students regarding their preferred work setting after graduation and the factors affecting their choice.

METHODS

A cross-sectional survey using a structured questionnaire was developed specifically for this study. The questionnaire was distributed among fourth-year students from all nursing training frameworks across Israel.

RESULTS

Of 281 respondents (76.6% women, average age, 29.3 years), most (80.9%) preferred working in hospitals, while 5% preferred community settings; 14% were undecided. Students' knowledge on hospital nurses' tasks was greater compared to their knowledge on community nurses' tasks. Moreover, hospital nurses' tasks were perceived as more important than those of community nurses. The contribution of clinical placement in hospital nursing was perceived as significantly more meaningful than the contribution of clinical placement in community nursing. The vast majority of students (94.3%) stated that they would prefer to undergo a hospital nursing internship. A significant correlation was noted between students' clinical placement, the exposure to community nursing roles, and the perception of the community nurse's role: clinical placements that were perceived as a positive experience led to a more positive perception of community nurses' roles.

CONCLUSIONS

Nursing students' perception of community nursing is based upon limited information which does not reflect community nurses' actual role and work.

Student nurses' career intentions following placements in general practice through the advanced training practices scheme (ATPS): findings from an online survey

BACKGROUND

The demand for General Practice services in the UK, and elsewhere, is rising quickly. In part, the increasing demand is from an aging population that requires management of multiple long-term conditions. The General Practice Nurse is increasingly taking on the role. It is acknowledged that if general practice is to be able to recruit sufficient General Practice Nurses (GPNs) to meet this increasing demand in the future, new graduate nurses must be encouraged to consider general practice as a viable career option. This research is part of a review of the Advanced Training Practice Scheme (ATPS) which supported clinical placements in participating general practices.

METHODS

The aim of the study was to examine nursing students' perceptions of GP placements, and their effect upon career intentions following graduation from Sheffield Hallam University (SHU), in the UK. Interviews and an online survey were used collect data. Only the survey is reported here. The bespoke survey examined students' views of: opportunities for learning new clinical skills and consolidating existing clinical skills; the learning environment in general practice and their views on a career in general practice.

RESULTS

One thousand one hundred twenty undergraduate adult-field nursing students were contacted, with a response rate of 41% (N = 462). Ninety respondents had a placement and, 92% (N = 84) viewed practice nursing positively, and 77% (N = 70) felt that the placement had transformed their views on general practice. The opportunity to participate in the management of the various aspects of chronic disease was identified by 84% (N = 76) of the students as a key new skill they had acquired. They also reported that they valued a team ethos, control over aspects of work, and the variety of health problems they encountered.

CONCLUSION

The findings from this study demonstrate a positive experience arising from the provision of General Practice placements for nursing students. The use of 'targeted' placement schemes with appropriate support such as this may be seen as a viable way of exposing nursing students to General Practice nursing, and of encouraging new graduate nurses to consider General Practice nursing as a viable career option.

The student experience of a 'kidney CAMP' as a primary care clinical placement for undergraduate nursing students

BACKGROUND

Historically clinical placements have been within acute care settings. In a more contemporary society, the future focus of health care is primary care, with an emphasis in expanding primary care clinical placements, to meet the needs of increasing workforce requirements. An innovative collaborative educational model was designed to provide a high quality learning experience and to increase numbers of students experiencing a primary care clinical placement.

OBJECTIVE

To explore student nurses' lived experiences within an innovative primary care setting.

METHODS

A qualitative case study was undertaken to analyse nursing students' experiences at the Kidney Kids Camp primary care clinical placement.

FINDINGS

Participants described how the primary care placement changed their view of nursing and the nurses' role. Five themes emerged from the research: developing knowing through children's eyes; entering the world of primary care; facing a journey of self-discovery; it's all in the way you communicate and; it makes you think differently about nursing.

DISCUSSION

The experience of this primary care placement enabled nursing students to enter the world of children living with chronic illness. Immersing students into this unique environment enabled them to gain a greater insight into primary care through the eyes of the children.

CONCLUSION

Kidney Kids camp experiences presented nursing students with an enhanced appreciation of primary care nursing, working with children, and an understanding of the impact of chronic health illnesses, through the primary care lens.

Building the English health visitor workforce as a result of the Health Visitor Implementation Plan 2011-2015: a survey study of career progression and retention for newly qualified health visitors

AIM

This study aimed to explore the extent to which health visitors who trained and qualified in both Greater London and the South West of England between September 2011 and January 2016 were employed in health visiting posts and have remained in the profession.

BACKGROUND

In 2011, the UK Government launched the Health Visitor Implementation Plan 'A Call to Action' (Department of Health, 2011) to develop the health visitor workforce by training 4200 health visitors over a four-year period. By April 2015, 4000 additional health visitors were trained, but the total workforce has since fallen back to pre-Implementation Plan size.

METHODS

Data were collected using a survey, completed online by participants. All participants had undertaken a health visitor education programme at one of two participating universities. The survey was distributed in January 2017 and completed by 180 individuals. Quantitative data were analysed using SPSS; association was assessed using individual chi-square tests or Fisher's exact test. Free-text responses were thematically analysed.

FINDINGS

Most (153; 87%) participants were still working as health visitors. Length of time spent working in the community prior to completing health visitor training was associated with staying in the role ( χ2 (with Fisher's exact test = 7.998, P = .027). Current pay was associated with attrition from the health visitor workforce ( χ2 (with Fisher's exact test) = 67.559, P < .001.). The majority who had left the health visitor role were on higher pay bands in their new post compared to those that had stayed (12; 60%). Bronfenbrenner's (1979) theory of socio-ecological development was used as a framework to interpret the results. While participants made an active choice to join the profession, leaving was influenced more by factors outside their control. To influence health visitor retention, both local and strategic changes are required.

Influencing nursing students' perceptions of community care with curriculum-redesign; a quasi-experimental cohort study

BACKGROUND

The shift in healthcare to extramural leads to more patients with complex health problems receiving nursing care at home. However, the interest of baccalaureate nursing students for community nursing is moderate, which contributes to widespread labour-market shortages. This study investigates the effect of a more 'community-care-oriented' curriculum on nursing students' perceptions of community care.

METHODS

A quasi-experimental quantitative survey study with a historic control group (n = 477; study cohorts graduating in 2015, 2016, and 2017; response rate 90%) and an intervention group (n = 170; graduating in 2018; response rate 93%) was performed in nursing students of a University of Applied Sciences in a large city in the Netherlands. The intervention group underwent a new curriculum containing extended elements of community care. The primary outcome was assessed with the Scale on Community Care Perceptions (SCOPE). The control and intervention group were compared on demographics, placement preferences and perceptions with a chi-square or T-test. Multiple regression was used to investigate the effect of the curriculum-redesign on nursing students' perceptions of community care.

RESULTS

The comparison between the control and intervention group on students' perceptions of community care shows no significant differences (mean 6.18 vs 6.21 [range 1-10], respectively), nor does the curriculum-redesign have a positive effect on students' perceptions F (1,635) = .021, p = .884, R2 = < .001. The comparison on placement preferences also shows no significant differences and confirms the hospital's popularity (72.7% vs 76.5%, respectively) while community care is less often preferred (9.2% vs 8.2%, respectively). The demographics 'working in community care' and 'belonging to a church/religious group' appear to be significant predictors of more positive perceptions of community care.

CONCLUSIONS

Graduating students who experienced a more 'community-care-oriented' curriculum did not more often prefer community care placement, nor did their perceptions of community care change. Apparently, four years of education and placement experiences have only little impact and students' perceptions are relatively static. It would be worth a try to conduct a large-scale approach in combination with a carefully thought out strategy, based on and tying in with the language and culture of younger people.

Attitude of Nursing and Midwifery students towards clinical practice and its associated factors in Northwest Ethiopia: a cross-sectional study

OBJECTIVE

The aim of this study was to assess the attitude of Nursing and Midwifery students towards clinical practice and its associated factors at University of Gondar, Northwest Ethiopia. 2018.

RESULT

The prevalence of a favorable attitude towards clinical practice was found to be 42.9% in this study. The odds of having favorable attitude were found to be 2 times higher among students who prepared well for clinical practice [AOR = 2.07, 95%, CI (1.25, 3.44)] compared with counterparts. Similarly students who communicate well with clinical staffs [AOR = 1.89, 95%, CI (1.05, 3.41)], practiced in well-equipped hospital [AOR = 1.76, 95%, CI (1.01, 3.06)], and accompanying frequently by a clinical supervisor [AOR = 1.69, 95%, CI (1.02, 2.81)] were more likely to have favorable attitude compared with counterparts.

When reach exceeds touch: Student experiences in a cross-sector community-based academic-practice partnership

OBJECTIVE

A partnership between three nursing programs, multiple high-needs public school districts and a local asthma coalition was developed as a way to build shared capacity aimed at improving health outcomes for children with asthma. This article explores student perceptions of their clinical experiences teaching asthma self-management within a regional cross-sector, community-based, multi-site academic-practice partnership.

DESIGN

Nursing faculty from three Long Island, New York-based nursing programs within the partnership jointly created a qualitative focus group methodology to more fully understand the phenomena of interest. A set of open-ended interview questions guided the sessions.

SAMPLE

Through purposive sampling, 42 undergraduate nursing students participated in 60-min focus group sessions.

MEASUREMENT

Focus group data were transcribed. Content analysis, coding, and theme development was carried out collaboratively. The unit of analysis was the individual participant responses informed by group interaction. A researcher diary was maintained.

RESULTS

One overarching theme and three sub-themes emerged from the data, reflecting student understandings in the areas of positioning, professional/personal identity, and social awareness. Ongoing analysis revealed patterns across the data sets linking student learning and the goals, milieu and workings of the partnership.

CONCLUSIONS

Findings suggest that the context of a thriving community-based academic-practice partnership, established to improve population health outcomes, offered unique clinical learning opportunities for students through exposure to the values, ideas, and innovation of the partnership itself.

An International Scoping Exercise Examining Practice Experience Hours Completed by Nursing Students

BACKGROUND

There is global acceptance of the need for prelicensure nursing students to complete practice experience hours during their program of education. Yet questions remain about these practice experiences, including those related to duration.

METHOD

This article reports findings of a scoping exercise that compared the number of practice experience hours mandated for students undertaking courses that lead to RN licensure in Australia, New Zealand, the United Kingdom, and the United States.

RESULTS

Substantial differences were evident between the four countries regarding the number of mandated practice experience hours. There is no clearly linked research evidence to justify the decision made in relation to the mandated number of hours.

CONCLUSION

Internationally, there is a need to reexamine the rationale for mandating a minimum number of practice experience hours for students in programs of education that lead to licensing as an RN. [J Nurs Educ. 2019;58(1):33-41.].

Experiences of registered nurses in a general practice-based new graduate program: a qualitative study

Nurses are increasingly needed in primary healthcare settings to support community-based healthcare delivery. Programs to facilitate transition of new graduate nurses are well established in acute care; however, there are few similar programs reported in settings like general practice. This paper sought to explore the experiences of new graduate registered nurses and their registered nurse mentors in a new graduate program within Australian general practice. New graduates (n = 9) and their mentors participated in interviews before, during and at the conclusion of a 12-month new graduate program. Interviews were digitally audio-recorded and professionally transcribed verbatim before being analysed using thematic analysis. Eighteen new graduate and 10 mentor interviews were conducted, revealing four themes. Preparation and Opportunities describes the influence that pre-registration education had on preparing nurses for general practice employment. Exceeding Expectations highlights the positive experiences within the program. Program Challenges draws attention to the difficulties experienced by participants, and Future Career Intentions explores future career plans. This study highlights that a general practice new graduate nurse program has the potential to build the workforce. However, strengthening undergraduate preparation of nurses around primary health care and addressing funding issues in general practice, are important to promote the success of such programs.

The perspectives of preceptors regarding clinical assessment for undergraduate nursing students

AIM

To explore the perspectives of preceptors about clinical assessment for undergraduate nursing students in transition to practice.

BACKGROUND

The assessment of clinical competence is a complex process due to the diverse nature of nursing practice. As such, nurse preceptors play a crucial role in clinical assessment for nursing students. Although preceptors may enjoy the process of clinical teaching and assessment, they face challenges that need to be addressed to facilitate students' clinical learning and assessment.

METHODS

An exploratory qualitative approach was adopted. A purposive sample of 17 preceptors from two tertiary hospitals in Singapore was recruited to participate in three focus group discussions from March to July 2014.

FINDINGS

Five themes emerged from the data analysis: the need for a valid and reliable clinical assessment tool; meaningful reflection and feedback; varied methods in clinical assessment; high level of commitment and struggles with dual roles and the need to enhance the support system for preceptors.

CONCLUSIONS

There is no doubt that a valid and reliable clinical assessment tool can serve as a guide for preceptors to enhance their clarity in assessment and feedback. It is essential for all stakeholders to be involved in the development of the clinical assessment tool. Workload, time, support system and formal educational programmes for preceptors influenced their preparation and self-confidence.

IMPLICATIONS FOR NURSING AND/OR HEALTH POLICY

The themes that emerged from the focus group discussions could assist in the development of a more reliable and valid clinical assessment tool to evaluate the clinical competence of nursing students in transition to practice. Clinical and educational institutions could collaborate closely to develop an educational programme and a preceptorship handbook, focusing on pedagogical contents for clinical education and assessment.

Mentoring students: exploring and managing incivil behaviour in community nursing placements

Students who demonstrate quiet incivility can be challenging and disrupt the learning that takes place in the community setting. Recognising incivility and acting to address this behaviour with students is difficult because the behaviour is not overt or obvious to others. The most important component in attempting to manage incivility is exploring the behaviour with the student to identify the potential cause, and negotiate a strategy to improve it. It is acknowledged that the behaviour may be due to personal, academic, or professional issues. If issues are not addressed, care activity and learning are affected, and this can result in failure to achieve in practice.