Moving from novice to expert - the value of learning in clinical practice: a literature review

Developing Competencies of Nurses in Wound Care: The Impact of a New Service Delivery Model Including Teleassistance

BACKGROUND

The implementation of a new wound care model of service delivery, including training and teleassistance, provided us with the opportunity to study nursing competencies in a primary health care context.

METHOD

A mixed-methods study was chosen to address the complexity related to the development of competencies from two complementary perspectives.

RESULTS

Nurses' self-perceived knowledge and skills improved immediately after training. Factors identified as influencing the development process were grouped into three themes: Acquired Skills and Knowledge, Personal Factors, and Work Organization Factors.

CONCLUSION

Our study demonstrates that the skills and knowledge can be enhanced through integrated continuing education efforts, and brings a deeper understanding of factors that influence the competency development. Finally, the research team highlighted the potential of telehealth technologies. [J Contin Educ Nurs. 2020;51(12):547-555.].

Using the cognitive apprenticeship model to identify learning strategies that learners view as effective in ward rounds

BACKGROUND

Cognitive apprenticeship model (CAM) is an instructional model for situated learning. There is limited data available on application of the CAM in clinical settings. The aim of the study was to identify learning strategies using CAM, which in the opinion of learners are effective in ward rounds.

METHODS

Participants were residents and medical students who rotated through internal medicine at Aga Khan University Hospital, Karachi. We sought learners' opinion on a structured questionnaire based on four principal dimensions of cognitive apprenticeship. A previously determined set of 10 defined competencies were compared with CAM's six teaching/learning (T/L) methods (modelling, coaching, scaffolding, articulation, reflection and exploration) as well. Mean and SD were calculated. Mann-Whitney test was used to compare scores.

RESULTS

Of 195 participants, there were 100 men (51.3%) and 95 women (48.7%). Perceived learning for six T/L methods, ranged from 3.7 to 3.9 (max=5). Coaching and scaffolding had the highest scores. Statistically significant difference between the student and resident groups was noted. Medical students perceived coaching and scaffolding (4.1 and 4.05) and residents rated coaching, articulation and exploration as most effective (3.9 and 3.8). Majority (82.1%) reported a positive learning environment in wards.

CONCLUSIONS

CAM enabled to identify two T/L methods (scaffolding and coaching) that are important for learning in ward round. Limited differences in perceived effectiveness of the T/L methods indicate that variety can be used to sustain interest in learners. Positive learning environment, team diversity and tasks of increasing complexity contribute to learning.

Nurse Educators' Guide to Clinical Judgment: A Review of Conceptualization, Measurement, and Development

AIM

The purpose of this article is to define clinical judgment, examine valid and reliable instruments to measure the construct, review established strategies by which to develop it, and propose key future nursing education research priorities in clinical judgment.

BACKGROUND

A pressing interest in prelicensure nursing students' clinical judgment development has emerged in response to the National Council of State Boards of Nursing project Next Generation NCLEX.

METHOD

Sequential literature reviews uncovered six instruments that measure clinical judgment and 24 studies that demonstrate the effects of high-fidelity simulation on clinical judgment in prelicensure learners.

RESULTS

Six themes emerged: number of simulation-based experience exposures, specific nursing specialty simulations, debriefing and its effect on clinical judgment, assessment, clinical decision-making, and reflection.

CONCLUSION

Based on these results, key future research priorities investigating the effects of interprofessional simulation and simulation in the classroom were identified.

Medical Claims at National Collegiate Athletic Association Institutions: The Athletic Trainer's Role

CONTEXT

National Collegiate Athletic Association (NCAA) institutions are required to certify insurance coverage of medical expenses for injuries student-athletes sustain while participating in NCAA events. Institutions assign this role to a variety of employees, including athletic trainers (ATs), athletic administrators, business managers, secretaries, and others. In 1994, Street et al observed that ATs were responsible for administering medical claim payments at 68.1% of institutions. Anecdotally, ATs do not always feel well suited to perform these tasks.

OBJECTIVE

To investigate the ways athletic associations and departments coordinate athletic medical claims and the role of ATs in this process.

DESIGN

Cross-sectional study.

SETTING

Online Web-based survey.

PATIENTS OR OTHER PARTICIPANTS

All 484 National Athletic Trainers' Association members self-identified as a head AT within an NCAA collegiate or university setting were solicited to respond to the online Web-based survey. Responses from 184 (38%) head ATs employed in collegiate settings were analyzed.

MAIN OUTCOME MEASURE(S)

Institutional demographic characteristics, type of insurance coverage, person assigned to handle insurance claims, hours spent managing claims, and training for the task.

RESULTS

In 62% of institutions, an AT was responsible for processing athletic medical claims. The head and assistant ATs spent means of 6.17 and 10.32 hours per week, respectively, managing claims. Most respondents (62.1%) reported no formal training in handling athletic medical insurance claims. When asked when and how it was most appropriate to learn these concepts, 35.3% cited within an accredited athletic training program curriculum, 32.9% preferred on-the-job training, and 31.1% selected via continuing education.

CONCLUSIONS

At NCAA institutions, ATs were responsible for administering athletic medical claims, a task in which most had no formal training. An AT may not possess adequate skills or time to handle athletic medical claims. Even if ATs are not solely responsible for this task, they remain involved as the coordinators of care. Athletic training programs, professional organizations that offer continuing education, and hiring institutions should consider focusing on and training appropriate personnel to manage athletic medical claims.

Communicating medication risk to cardiovascular patients in Qatar

Purpose

Patient safety is gaining prominence in health professional curricula. Patient safety must be complemented by teaching and skill development in practice settings. The purpose of this paper is to explore how experienced pharmacists identify, prioritize and communicate adverse drug effects to patients.

Design/methodology/approach

A focus group discussion was conducted with cardiology pharmacy specialists working in a Doha hospital, Qatar. The topic guide sought to explore participants’ views, experiences and approaches to educating patients regarding specific cardiovascular therapy safety and tolerability. Discussions were audio-recorded and transcribed verbatim. Data were coded and organized around identified themes and sub-themes. Working theories were developed by the three authors based on relevant topic characteristics associated with the means in which pharmacists prioritize and choose adverse effect information to communicate to patients.

Findings

Nine pharmacists participated in the discussion. The specific adverse effects prioritized were consistent with the reported highest prevalence. Concepts and connections to three main themes described how pharmacists further tailored patient counseling: potential adverse effects and their perceived importance; patient encounter; and cultural factors. Pharmacists relied on initial patient dialogue to judge an individual’s needs and capabilities to digest safety information, and drew heavily upon experience with other counseling encounters to further prioritize this information, processes dependent upon development and accessing exemplar cases.

Originality/value

The findings underscore practical experience as a critical instructional element of undergraduate health professional patient safety curricula and for developing associated clinical reasoning.

Translational Acceleration, Rotational Speed, and Joint Angle of Patients Related to Correct/Incorrect Methods of Transfer Skills by Nurses

Currently, due to shortages in the nursing faculty and low access to actual patients, it is difficult for students to receive feedback from teachers and practice with actual patients to obtain clinic experience. Thus, both evaluation systems and simulated patients have become urgent requirements. Accordingly, this study proposes a method to evaluate the nurse’s transfer skill through observation from the patient. After verifying the proposed method, it will be integrated with a robotic patient as a future work. To verify if such an evaluation is practical, a checklist comprising 16 steps with correct and incorrect methods was proposed by the nursing teachers. Further, the evaluation parameters were determined as translational acceleration, rotational speed, and joint angle of patient. Inertial sensors and motion capture were employed to measure the translational acceleration, rotational speed, and joint angle. An experiment was conducted with two nursing teachers, who were asked to carry out both correct and incorrect methods. According to the results, three parameters reveal the difference for a patient under correct/incorrect methods and can further be used to evaluate the nurse’s skill once the thresholds are determined. In addition, the applicability of inertial sensors is confirmed for the use of robot development.

Embedding evidence-based practice among nursing undergraduates: Results from a pilot study

Evidence-based practice is currently one of the most important developments in health care. Research in nursing science is rapidly growing; however, translating the knowledge based on this research into clinical practice is often hampered, and may be dependent on reflective skills. The aim of this study was to see how undergraduate nursing students in nursing should increase their skills and knowledge related to evidence-based practice through participation in clinical research projects. A qualitative approach was used in collecting and analyzing the data. Students participated in a pilot clinical research project and a received guidance related to their bachelor thesis. After the project was completed, all students filled in a questionnaire. The students' motivation to participate in this study was reported to be high, but they reported low knowledge related to evidence-based practice. All students reported that their attitude towards evidence-based practice changed in a positive direction during their participation in the project. Evidence-based practice influenced nursing practices by putting more focus on critical thinking, increasing pride and giving a sense of ownership in the clinical field. The curricula and the pedagogical perspectives in nursing education can influence the attitude towards evidence-based practice and skills among nursing bachelor students.

Pattern of Hepatitis A Virus Epidemiology in Nursing Students and Adherence to Preventive Measures at Two Training Wards of a University Hospital

BACKGROUND

Nursing students can be exposed to patients with hepatitis A virus (HAV) and can represent a vehicle of transmission both for health personnel, patients and relatives.

OBJECTIVES

The aim of this study was to assess the risk of HAV infection in nursing students during their internship.

PATIENTS AND METHODS

A seroprevalence survey on HAV infection was performed on nursing students at the Cagliari university-hospital, together with the assessment of the compliance to preventive measures to decrease the risk of infection during their internship. Blood specimens were obtained from 253 students. All serum samples were tested for anti-HAV antibodies (IgG) by the enzyme-linked immunosorbent assay (ELISA). Compliance to preventive measures was recorded by trained personnel.

RESULTS

Overall HAV seropositivity in nursing students (mean age 24, range 17 - 45 years) was 3%. Compliance to preventive measures was not uniform (6% - 76%) and extremely low in some specific measures targeted to decrease the oral-fecal transmission.

CONCLUSIONS

The high proportion of susceptible nursing students can contribute to an increase in the risk of nosocomial transmission, especially when specific preventive measures are not completely applied. Nursing education packages, before starting medical internship, should be implemented in order to increase their compliance to preventive measures, especially in wards at higher risk. Vaccination should be considered in wards at higher risk.

Realizing nursing: a multimodal biopsychopharmacosocial approach to psychiatric nursing

The biological and psychosocial components of health, illness and treatment are well recognized. In addition, pharmacological interventions interact with both these components regarding health and illness; all components are potentially modifiable. A better understanding of these interactions on the course of illness, especially at the interface between illness and treatment, is needed to guide effective clinical and psychiatric nursing interventions. To this end, a multimodal biopsychopharmacosocial approach to assessment, formulation, care planning and implementation by psychiatric nurses is proposed. It is argued that a biopsychopharmacosocial approach, including a multimodal functional element, provides a person-centred, responsive and responsible basis for a comprehensive approach to practice. The use of this approach will improve intervention outcomes and contribute to the ongoing development of psychiatric nursing practice. It is suggested that, in part, this will be achieved through innovative teaching methods delivered by 'expert nurses' and clinical academics.

Applications of social constructivist learning theories in knowledge translation for healthcare professionals: a scoping review

Background

Use of theory is essential for advancing the science of knowledge translation (KT) and for increasing the likelihood that KT interventions will be successful in reducing existing research-practice gaps in health care. As a sociological theory of knowledge, social constructivist theory may be useful for informing the design and evaluation of KT interventions. As such, this scoping review explored the extent to which social constructivist theory has been applied in the KT literature for healthcare professionals.

Methods

Searches were conducted in six databases: Ovid MEDLINE (1948 – May 16, 2011), Ovid EMBASE, CINAHL, ERIC, PsycInfo, and AMED. Inclusion criteria were: publications from all health professions, research methodologies, as well as conceptual and theoretical papers related to KT. To be included in the review, key words such as constructivism, social constructivism, or social constructivist theories had to be included within the title or abstract. Papers that discussed the use of social constructivist theories in the context of undergraduate learning in academic settings were excluded from the review. An analytical framework of quantitative (numerical) and thematic analysis was used to examine and combine study findings.

Results

Of the 514 articles screened, 35 papers published between 1992 and 2011 were deemed eligible and included in the review. This review indicated that use of social constructivist theory in the KT literature was limited and haphazard. The lack of justification for the use of theory continues to represent a shortcoming of the papers reviewed. Potential applications and relevance of social constructivist theory in KT in general and in the specific studies were not made explicit in most papers. For the acquisition, expression and application of knowledge in practice, there was emphasis on how the social constructivist theory supports clinicians in expressing this knowledge in their professional interactions.

Conclusions

This scoping review was the first to examine use of social constructivism in KT studies. While the links between social constructivism and KT have not been fully explored, the Knowledge to Action framework has strong constructivist underpinnings that can be used in moving forward within the broader KT enterprise.

Nutritional screening among patients with cancer in an acute care hospital: a best practice implementation project

AIM

This project sought to improve the nutritional screening practice among registered nurses in caring for adult patients with cancer.

METHODS

This project used the pre- and post-implementation audit strategy using Joanna Briggs Institute Practical Application of Clinical Evidence System and Getting Research into Practice (JBI-PACES) module. The audit, feedback and re-audit sequence was the strategy used to improve clinical practice. This project ran over three phases during a 5-month period from July to November 2011.

RESULTS

This project utilised three criteria from the JBI-PACES. The criteria are: (i) a validated screening tool is used to identify patients at risk for malnutrition; (ii) patients are screened upon admission using a validated screening tool; and (iii) appropriate action plans are initiated when at-risk patients for malnutrition are identified. According to the pre-implementation audit, only Criterion 1 showed 100% compliance. Criterion 2 and 3 showed 96% and 46% compliance, respectively. The audit team identified four barriers and developed action plans, which included a simplified nutritional screening tool and empowerment of the nurses for dietician referral. The post-implementation audit showed 100% compliance rate achieved for all the three criteria.

CONCLUSION

This project used the pre- and post-audit strategy to translate evidence into practice. It demonstrated not only that implementation of best practice is possible in a busy oncology ward, but also showed a remarkable improvement in the nutritional screening of patients with cancer.

The role of the clinical preceptor: an integrative literature review

The clinical learning environment has been identified as being central to nursing education. The clinical learning environment provides undergraduate nursing students with the opportunity to combine cognitive knowledge with the development of psychomotor and affective nursing skills. The preceptor role in undergraduate nursing education is complex and multifaceted. Undergraduate nursing students identify preceptors as key to their learning in the clinical setting; however, staff nurse preceptors often feel unprepared to serve in this role. This integrative literature review explores the role of the staff nurse preceptor through the perspective of undergraduate nursing students, nursing faculty, and staff nurses who are assigned to precept students as a function of their nursing role. Recommendations are made to facilitate the preparation of clinical preceptors to fulfill this essential role in preparing nursing students for clinical practice.

Finnish and Swedish nursing students' experiences of their first clinical practice placement--a qualitative study

BACKGROUND

Nursing is a practice-based discipline. Clinical practice settings are important in preparing undergraduate nursing students for the role of registered nurse.

AIM

The aim of this Nordic qualitative study is to illuminate first year undergraduate nursing students' experiences of clinical practice during their first clinical placement, with a focus on preception, reflection, and the link between theory and practice.

METHOD

Data were collected by focus group interviews with 22 nursing students, and analyzed with qualitative content analysis.

FINDINGS

Positive experiences included stimulating and visible preceptors, a permissive atmosphere, and reflection as a matter of course. Negative experiences were related to feelings of abandonment and powerlessness when preceptors were invisible and the atmosphere at the ward was non-permissive. The implementation of research-based knowledge was insufficient.

CONCLUSIONS

A permissive atmosphere and visible preceptors are crucial if learning is to be maximized. Consequently, it is important to set aside time for preceptors to be more visible and to make the atmosphere at the clinical placement more permissive. The student must have the opportunity to combine scientific knowledge with evidence-based knowledge in order to develop nursing actions.

Nursing students' views of sociocultural factors in clinical learning: a qualitative content analysis

AIM

The aim of this study is description of nursing students' views of sociocultural factors in clinical learning.

METHODS

A qualitative content analysis was conducted to describe nursing students' views of sociocultural factors in clinical learning. The participants consisted of 21 nursing students. Semi-structured and interactive interviews were used to collect data. All the interviews were recorded and transcribed, and then, they were analyzed using Qualitative Content Analysis and Max Qualitative Data Analysis 2010.

RESULTS

From the transcripts, a remarkable number of primary themes, main themes, and sub-themes emerged. The main themes consisted of elements related to "society and culture", "family", "staff", and "classmates". The themes encompassed a spectrum of facilitators of and impediments to clinical learning.

CONCLUSION

The findings showed that the administrators of nursing education should coordinate with faculty and staff by adopting interactive and participatory solutions, including the establishment of clinical learning teams and the transformation of hospitals into suitable sociocultural environments for education.

The clinical seminar as a learning methodology: an evaluation of nursing students' views

OBJECTIVE: To explore students' assessments of the clinical seminar as a complementary teaching method to the clinical practicum experience. METHODS: This was a qualitative study based on the hermeneutic phenomenology of Gadamer. Twenty-three open-ended interviews were conducted from among the 132 first-year students who attended an initial clinical practicum. We performed a qualitative analysis of the data using ATLAS.ti software. RESULTS: The students agreed that the clinical seminar gave them the opportunity to learn about procedures, nursing care and interpersonal relationships. They also found it very helpful when they encountered challenging stressful situations as they performed their practice, and believed it allowed them to make a connection between the theory in the classroom and the clinical practice. CONCLUSIONS: These seminars can contribute to reducing levels of stress during clinical practice. They can also help students obtain significant learning from their fellows and reduce the theory-practice gap.

Rediscovering the essence of nursing: exploring the impact of in clinical experience in Thailand for undergraduate nursing students from Australia

Cultural competence is now widely recognised as an essential characteristic for undergraduate nursing students. Clinical experience in foreign countries has become increasingly popular as a strategy to enhance cultural awareness and competence. However, published research articulating the experience and outcomes of these initiatives is relatively rare, particularly from an Australian perspective. This paper presents the findings of a qualitative, exploratory research project. Individual semi-structure interviews were conducted with eight undergraduate nursing students before, during and at the conclusion of a four week clinical placement in Surin, Thailand. Data analysis identified the following major themes: first interview - anticipation; second interview - making a difference; contrasting worlds; and part of the group; third interview - reality check and group dynamics. These findings suggest that international clinical experience has potential benefits beyond the development of cultural competence. The importance of caring in nursing and the importance of group dynamics were particularly valued by student participants.

Strategies used by experienced versus novice practice teachers to enact their role with community nurse students

This study offers an original analysis of how community nurse practice teachers learn to enact their role. A constructivist grounded theory approach was applied to a study of thirty community nurse practice teachers. Practice teachers were interviewed using a lightly structured interview approach following ethical approval. The study found that practice teachers considered relationships and nurturance to be of central importance. This led to emphasis being placed on providing experience for students and formative assessment. A number of key differences between the way novice and experienced practice teachers saw themselves functioning were discovered. These differences were theorised to explain the finding that novice practice teachers were much more likely to identify students as experiencing major difficulties than experienced practice teachers. It was discovered that practice teachers learn to enact their role within a socio-cultural context drawing upon a transformation approach to learning. This approach becomes firmly established over a period of approximately three years and is at odds with the current emphasis on competency based transmission models of learning.

An integrative review of expert nursing practice

PURPOSE

To review relevant literature on expert practice in nursing to assess common characteristics across the breadth of nursing specialties and work settings.

ORGANIZING CONSTRUCT

An integrative literature search was conducted with inclusion criteria: (a) primary studies of how clinical staff nurses develop and demonstrate expert practice; (b) subjects from variety of specialties, employment settings, and countries of origin; and (c) studies of clinical staff nurses and not nurses in advanced practice roles.

METHODS

Literature published between 1996 and 2009 was reviewed using MEDLINE and the Cumulative Index of Nursing and Allied Health Literature (CINAHL) using the key words "nursing,""expert," and "practice."

FINDINGS

The characteristics of expert practice as explicated across a variety of specialty areas of practice and international settings included the following: knowing the patient, intuitive knowledge, reflective practice, risk taking, and skilled know-how. Involvement and engagement of the expert nurse with her or his patients underpin these characteristics. Themes were illustrated in a star model of nursing expert practice surrounded by support and grounded in emotional involvement.

CONCLUSIONS

Expert practice develops as nurses gain experience in a specialized practice setting, reflect on and learn from their experience, and develop meaningful relationships with their patients, families, and colleagues.

CLINICAL RELEVANCE

The findings provide an understanding of expert nursing practice that can serve as a foundation for efforts to transfer knowledge from expert nurses to less expert nurses in all practice settings to reduce the expertise gap that is now widening.

Mentoring overseas nurses: barriers to effective and non-discriminatory mentoring practices

In this article it is argued that there are barriers to effective and non-discriminatory practice when mentoring overseas nurses within the National Health Service (NHS) and the care home sector. These include a lack of awareness about how cultural differences affect mentoring and learning for overseas nurses during their period of supervised practice prior to registration with the UK Nursing and Midwifery Council. These barriers may demonstrate a lack of effective teaching of ethical practice in the context of cultural diversity in health care. This argument is supported by empirical data from a national study. Interviews were undertaken with 93 overseas nurses and 24 national and 13 local managers and mentors from six research sites involving UK health care employers in the NHS and independent sectors in different regions of the UK. The data collected showed that overseas nurses are discriminated against in their learning by poor mentoring practices; equally, from these data, it appears that mentors are ill-equipped by existing mentor preparation programmes to mentor overseas-trained nurses from culturally diverse backgrounds. Recommendations are made for improving mentoring programmes to address mentors' ability to facilitate learning in a culturally diverse workplace and thereby improve overseas nurses' experiences of their supervised practice.

A socio-cultural approach to learning in the practice setting

Practice learning is an essential part of the curriculum and accounts for approximately 60% of the current pre-registration nursing programmes in the Republic of Ireland. The nature and quality of the clinical learning environment and the student nurses' experience of their practice placements is recognised as being influential in promoting the integration of theory and practice. However, the problem experienced by many learners is how to relate their theoretical knowledge to the situation-at-hand within the practice setting. Socio-cultural or activity theories of learning seek to explain the social nature of learning and propose that knowledge and learning are considered to be contextually situated. Lave and Wenger (1991) argue that learning is integrated with practice and through engagement with a community of practice, by means of sponsorship; students become increasingly competent in their identity as practitioners. This paper examines the changes which have occurred within the pre-registration nursing curriculum in the Republic of Ireland with the transition from the apprenticeship system to the graduate programme, and the resulting reduction in clinical learning hours. It also examines the potential impact on the development of student learning with the implementation of the concepts proposed by Lave and Wenger to learning in the practice setting.

Understanding clinical expertise: nurse education, experience, and the hospital context

Clinical nursing expertise is central to quality patient care. Research on factors that contribute to expertise has focused largely on individual nurse characteristics to the exclusion of contextual factors. To address this, we examined effects of hospital contextual factors and individual nurse education and experience on clinical nursing expertise in a cross-sectional analysis of data from 8,611 registered nurses. In a generalized ordered logistic regression analysis, the composition of the hospital staff, particularly the proportion of nurses with at least a bachelor of science in nursing degree, was associated with significantly greater odds of a nurse reporting a more advanced expertise level. Our findings suggest that, controlling for individual characteristics, the hospital context significantly influences clinical nursing expertise.

Subjectivity and the valid assessment of pre-registration student nurse clinical learning outcomes: implications for mentors

This discussion, supported by the author's personal reflections as a mentor and teacher, examines the issue of subjectivity when assessing the competence of pre-registration nursing students during their clinical placements. A difference is highlighted between valid and invalid subjectivity affecting the quality of mentors' assessments. Valid subjectivity refers to situations where students and mentors enter into a contract of trust and commitment from the outset of placement learning, enabling the 'substantiated' opinion of mentors to become a credible part of proficiency assessment. Invalid subjectivity presupposes that there has been limited investment in the student/mentor relationship and that assessment is therefore more reliant on the 'unconfirmed' views of mentors. Humanistic approaches to evaluating student learning are explored and a question is posed as to whether the trustworthiness of subjective assessment is improved when there is a sense of mutual reciprocity between students and mentors. Particular reference is made to reflective practice in adding meaning to this connection. Finally, an example of holistic assessment during 'live' clinical supervision involving a student and this author is offered (Table 1), in order to illustrate the implications for mentors attempting to enhance subjective evaluation of student learning.

Towards an alternative to Benner's theory of expert intuition in nursing: A discussion paper

Several authors have highlighted the role of intuition in expertise. In particular, a large amount of data has been collected about intuition in expert nursing, and intuition plays an important role in the influential theory of nursing expertise developed by Benner [1984. From Novice to Expert: Excellence and Power in Clinical Nursing Practice. Addison-Wesley, Menlo Park, CA]. We discuss this theory, and highlight both data that support it and data that challenge it. Based on this assessment, we propose a new theory of nursing expertise and intuition, which emphasizes how perception and conscious problem solving are intimately related. In the discussion, we propose that this theory opens new avenues of enquiry for research into nursing expertise.

Newly qualified Irish nurses' interpretation of their preparation and experiences of registration

AIMS AND OBJECTIVES

The aim of this paper is to report on the insights of newly qualified Irish nurses into their preparation for registration as general nurses and to develop insights into the postregistration experience.

BACKGROUND

Nurse education in Ireland has undergone much reform over the past decade. These changes include the introduction of supernumerary status for nursing students and the formation of links with institutes of higher education. No Irish literature was found on this subject.

METHOD

Individual semi-structured, in-depth interviews were held with 12 newly registered nurses, from two cohorts, within 10 months of qualification. A grounded theory approach was adopted and content analysis employed to analyse the data.

RESULTS

Two categories, entitled Learning the Ropes and The Metamorphosis emerged from the analysis of data. Within each of these categories there were two subcategories. All respondents reported that since qualification, they had become increasingly conscious of their isolation and unmet needs as nursing students. Postregistration, they enjoyed their increased status and widespread recognition by others.

CONCLUSIONS

This study details how improvements can be made at clinical level to assist the preparation of nursing students for registration. The positive aspects of registration are revealed through descriptions of comparisons of pre- and postregistration experiences, while the shortcomings of the journey to registration are described.

RELEVANCE TO CLINICAL PRACTICE

Pre-registration nurses have unmet clinical needs which, if fulfilled, would benefit them post-registration. Good ward morale is elementary for student learning and enhances the post-registration experience. Registered nurses are highly conscious of their altered status. These findings are pertinent to clinicians and educationalists as they prepare nursing students for practice.

Clinical education: A review of the literature

In 2005, the University of Sheffield was commissioned to research the role, function and perceived impact of the clinical nurse educator role in a National Health Service Primary Care Trust. This paper presents the results of Phase I of the study, a review of the literature on clinical education and the series of research questions that were indicated. The importance of clinical education for quality nursing care has long been agreed but has gained increasing attention over the last two decades. This increased attention is the result of policy directives that place work based learning at the centre of health and social care practice. The literature is less equivocal, however, concerning the responsibility for clinical education and asserts various roles including; the lecturer employed by the University; joint appointments; mentors; ward sister; specialist and advanced practitioners including the nurse consultant; and more recently the clinical nurse educator. Clinical educators have reported to have been introduced to meet the professional educational needs of the workforce but there is little empirical or theoretical evidence to support or refute this. This paper is an attempt to begin to address this.

Enabling student placement through strategic partnerships between a health-care organization and tertiary institutions

Nursing management needs to demonstrate its commitment to clinical education for undergraduate nursing students. The vision for the nursing leadership and management team at Princess Alexandra Hospital is to guide and support the development of hospital clinicians, at all levels in the organization, to effectively facilitate undergraduate students' learning during their clinical practical experiences. This paper examines the evolution of the meaning, commitment and practices that have been intrinsic to the development of strategic partnerships between the health-care organization and tertiary institutions to ensure that hospital staff who consistently facilitate student learning in the clinical context are well supported. The partnerships are based on open channels of communication between the health-care organization and the tertiary institutions whereby each party identifies its needs and priorities. This has resulted in increased hospital staff satisfaction through greater involvement by them in the placements of students, and enhanced understanding of clinicians of the student placement process that has contributed to improved satisfaction and outcomes for the students.

Developing clinical placements in times of scarcity

This article takes the position that the current shortage of clinical placements may be creating problems, but it can also be seen as an opportunity to reconsider the design of students' clinical experiences and the goals to be attained. It begins with a description of paradoxes in professional education. The following sections examine some of the considerations which need to be incorporated in the development of clinical placements and the way they are incorporated into health care courses. The considerations germane to clinical placement development include social participation in clinical settings, communities of learning, and consumer-centred inter-professional collaboration.

Students' perception of the psycho-social clinical learning environment: an evaluation of placement models

Nursing is a practice based discipline. A supportive environment has been identified as important for the transfer of learning in the clinical context. The aim of the paper was to assess undergraduate nurses' perceptions of the psychosocial characteristics of clinical learning environments within three different clinical placement models. Three hundred and eight-nine undergraduate nursing students rated their perceptions of the psycho-social learning environment using a Clinical Learning Environment Inventory. There were 16 respondents in the Preceptor model category, 269 respondents in the Facilitation model category and 114 respondents in the clinical education unit model across 25 different clinical areas in one tertiary facility. The most positive social climate was associated with the preceptor model. On all subscales the median score was rated higher than the two other models. When clinical education units were compared with the standard facilitation model the median score was rated higher in all of the subscales in the Clinical Learning Environment Inventory. These results suggest that while preceptoring is an effective clinical placement strategy that provides psycho-social support for students, clinical education units that are more sustainable through their placement of greater numbers of students, can provide greater psycho-social support for students than traditional models.