Nursing students' perceptions of learning in practice environments: a review

Bridging School and Practice? Barriers to the Integration of 'Boundary Objects' for Learning and Assessment in Clinical Nursing Education

Introduction

In clinical health professions education, portfolios, assignments and assessment standards are used to enhance learning. When these tools fulfill a bridging function between school and practice, they can be considered 'boundary objects'. In the clinical setting, these tools may be experienced as time-consuming and lacking value. This study aimed to investigate the barriers to the integration of boundary objects for learning and assessment from a Cultural-Historical Activity Theory (CHAT) perspective in clinical nursing education.

Methods

Nineteen interviews and five observations were conducted with team leads, clinical educators, supervisors, students, and teachers to obtain insight into intentions and use of boundary objects for learning and assessment. Boundary objects (assessment standards, assignments, feedback/reflection/patient care/development plan templates) were collected. The data collection and thematic analysis were guided by CHAT.

Results

Barriers to the integration of boundary objects included: a) conflicting requirements in clinical competency monitoring and assessment, b) different application of analytical skills, and c) incomplete integration of boundary objects for self-regulated learning into supervision practice. These barriers were amplified by the simultaneous use of boundary objects for learning and assessment. Underlying contradictions included different objectives between school and practice, and tensions between the distribution of labor in the clinical setting and school's rules.

Discussion

School and practice have both convergent and divergent priorities around students' clinical learning. Boundary objects can promote continuity in learning and increase students' understanding of clinical practice. However, effective integration requires for flexible rules that allow for collaborative learning around patient care.

Evaluating satisfaction with teaching innovation, its relationship to academic performance and the application of a video-based microlearning

AIM

To develop and validate a questionnaire to assess satisfaction with teaching innovation, assess the student satisfaction with a video-based microlearning intervention in its video-based modality and to verify its impact on academic performance.

DESIGN

A descriptive cross-sectional study was conducted. The study used the COSMIN checklist for studies on measurement instruments.

METHODS

One hundred and ten nursing students from Salus Infirmorum University Centre (Andalusia, Spain) participated in the study. The items of the instrument were designed based on a literature review and its validity and stability were analysed. After that, 6 weeks of video-based microlearning intervention were implemented. Then students were asked to fill the satisfaction questionnaire and then took the subject exam.

RESULTS

The resulting questionnaire consisted of 5 items with only one dimension. The questionnaire showed good validity and reliability. A direct correlation was observed between satisfaction with the video-based microlearning intervention and the marks of the subject exam.

Psychometric properties of Clinical Learning Environment Inventory and its association with Moroccan nursing students' satisfaction: A PLS-SEM approach

Background

The Clinical Learning Environment (CLE) is integral to pre-registration nursing curricula. Assessing the student's perceptions of their CLE is essential to adjust clinical placement to trainees' needs. Clinical Learning Environment Inventory (CLEI) appears to be widely used in measuring CLE, but no previous study has reported a full structural validity and its association with students' satisfaction in the Moroccan context.

Objectives

This study investigated the psychometric properties of the CLEI and its subscales association with Moroccan nursing students' satisfaction.

Methods

The research design was descriptive, cross-sectional, and conducted from March and June 2022 using convenience sampling in three nursing institutes of the Fez-Meknes region of Morocco. The selected sample involved Moroccan nursing students undertaking clinical practice. First, exploratory factor analysis (EFA) was used to determine the factor structure of the pilot sample (N = 143). The second sample (N = 206) was then used to confirm this structure using partial least squares structural equation modeling (PLS-SEM) confirmatory composite analysis (CCA). Finally, using a bootstrapping method, the significance of the structural path was evaluated.

Results

The CLEI scale depicted convergent validity (AVE = 0.56 - 0.71), discriminant validity, estimated by the square roots of AVE and bootstrapped HTMT confidence interval, and significant reliability (rhoC = 0.83 - 0.92). Using a bootstrapping approach, structural path significance displayed a substantial association between task orientation and students' satisfaction (β = 0.29, p <0.001). This ascertains that nurse students need well-planned guidelines from their facilitators in clinical wards.

Conclusions

The CLEI instrument revealed adequate psychometric properties and supported its original structure. As a result, the instrument might be used to measure students' perceptions of their CLE. Task orientation appeared to be the most important factor influencing the students' satisfaction in CLE.

A Multisite Assessment of Saudi Bachelor Nursing Students' Perceptions of Clinical Competence and Learning Environments: A Multivariate Conceptual Model Testing

Background: It is thought that students’ perceptions of educational and clinical learning environments improve the effectiveness of curricula and professional standards. It is essential to examine the educational and clinical learning environments in which nursing students learn, as well as how nursing students evaluate particular factors of these environments. Objectives: The objectives of this study were to (1) identify nursing students’ perceptions on professional competence and learning environments in the classroom and clinical settings and (2) test a hypothetical model of variables that influence and predict students’ perceptions of learning environments and professional competencies. Methods: The study employed a descriptive cross-sectional methodological design. Five hundred and eighteen undergraduate nursing students were recruited from three Saudi Arabian universities using a convenient sampling technique. Using valid and reliable self-reported questionnaires, including the Dundee Ready Educational Environment Measure (DREEM), the modified Clinical Learning Environment Inventory (CLEI), and the Nurse Professional Competence Scale-Short (NPCS-SF), data were collected. Results: Perceptions of professional competence and learning environments were positive among nursing students. With satisfactory fit indices, the final model found that students’ perceptions of clinical competence were significantly predicted by their perceptions of the clinical environment (B = 0.43, p < 0.001), students’ perceptions of university environments (B = 0.29, p < 0.001), ward type (B = 0.12, p < 0.001), and students’ year of study (B = 0.11, p < 0.001). The students’ perceptions of clinical environments were significantly predicted by their perceptions of the university environment (B = 0.31, p < 0.001), gender (B = 0.13, p < 0.001), students’ year of study (B = 0.12, p < 0.001), and ward type (B = 0.11, p < 0.001). Moreover, the students’ perceptions of the university environment were significantly predicted by gender (B = 0.11, p < 0.001) and length of training (B = 0.12, p < 0.001). Conclusions: A range of factors might influence students’ perceptions of their professional competence and learning environments. Improving the learning environments and clinical experiences of students could enhance their clinical competence. This study’s findings provide evidence for how to enhance the learning environments in the classroom and clinical settings in order to improve students’ clinical competence, which will ultimately result in better patient outcomes. It is a top priority for nursing educators all around the world to improve classroom and clinical learning settings that foster students’ learning and professional competencies.

Learning in and across communities of practice: health professions education students' learning from boundary crossing

Learning to adapt to new contexts is crucial in health professions education (HPE). Boundaries between and within contexts challenge continuity in students' learning processes. Little is known about how HPE students can make these "boundary experiences" productive for learning. We investigated how and what nursing students learn from boundary experiences while they are simultaneously growing into a community of practice (CoP). Using a boundary-crossing lens, experiences of discontinuity were identified in pre-placement and post-placement interviews and diary fragments with 14 nursing students during their placement in an academic hospital. We found that students experience discontinuity as a result of different approaches to nursing care and to learning, both between (academic and clinical) settings and within a setting. When students feel safe enough, they can convert boundary experiences into meaningful learning situations, such as critical discussions with staff. Successfully overcoming boundary experiences improves students' understanding of healthcare and professional development and helps them to develop a personal approach to learning. Students critically address boundary experiences when they are motivated to learn and when they perceive a violation of ethical standards but not when they are concerned that it will affect their assessment. Objects designed to bridge theory and practice can generate additional barriers. This study adds to the HPE literature by demonstrating the learning potential of boundaries and to the broader literature by showing how responses to boundary experiences are intertwined with the process of growing into a CoP. The findings can be used to design future boundary objects.

Levels of motivation and basic psychological need satisfaction in nursing students: In perspective of self-determination theory

BACKGROUND

Motivation is the first and most important constituent element of learning behavior. One of the most important theories in this field is self-determination theory (SDT) which is a general theory of motivation. According to this theory, the satisfaction of basic psychological needs of autonomy, competence, and relatedness are effective in the internalization of incentive. Hence this theory can be a good foundation for reforming medical education programs.

OBJECTIVE

The aim of this study was determining the basic psychological need and the effect of it on level of motivation and self-determined motivation of nursing student in the field.

METHODS

This is a cross-sectional, descriptive-analytical study done through a census on 243 nursing students of Guilan University of Medical Sciences. Data gathering tool was demographic information, motivation level, and basic psychological needs questionnaire. Data were analyzed using independent t-test, Spearman and Pearson correlation, Man-Whitney, backward regression considering P < 0.05.

RESULTS

The findings showed that the majority of students (51.9 %) were female and, the mean age was 21 years. Statistical tests indicated a significant relationship between levels of motivation, basic psychological needs, and demographic variables. However, the regression coefficients indicated that the need for competence and relatedness could be a suitable predictor for internal motivation.

CONCLUSION

Basic psychological needs satisfaction, especially needs of competence and relatedness in the clinical field by instructors can lead to internalization of their incentive and positive outcomes.

A district nurse's reflection on pre-registration nursing education: a troubling position

This article explores the author's observations as a qualified district nurse and senior lecturer in pre-registration nurse education. Perceived 'troubling' reflections suggest pre-registration nurse education appears very hospital focussed. Additionally, the role of the district nurse has become synonymous with the term 'community nurse', hiding the historical specialism it represents. Media representations of the term 'frontline' was particularly noted in relation to COVID-19, suggesting a heroism of nursing that only happened in hospital. More discussion will take place around how nursing is viewed within education by students, such as what we do to patients (catheterisation, blood sugars etc) rather than how we can work with them. All these areas appear to strengthen lingering historical myths around district nursing and student perceptions of this specialist profession.

Effects of five teaching methods in clinical nursing teaching: A protocol for systematic review and network meta-analysis

Introduction

Several teaching methods have been used in clinical nursing teaching to increase quality and efficiency, but disagreements over their effects persist. This study will evaluate the effects of five teaching methods in clinical nursing on nursing students’ knowledge, skill scores, learning satisfaction, and patients’ satisfaction.

Methods

We will conduct searches in PubMed, Embase, Web of Science, The Cochrane Library, China National Knowledge Infrastructure Database (CNKI), China Biological literature database (CBM), Wanfang Database, and China Science and Technology Journal Database (CSTJ) up to April 2022. Relevant randomized controlled trials meeting the eligibility criteria will be included. And the study selection and data extraction will be independently screened for eligibility by two authors. The quality of evidence will be evaluated using the Cochrane risk of bias tool. Pairwise meta-analysis and network meta-analysis (NMA) will be conducted using Rev Man, Stata, and R software. Statistical analyses including homogeneity tests, sensitivity analysis, transitivity tests, consistency tests, and publication bias will be completed.

Ethics and dissemination

No formal research ethics approval is required. The results will be disseminated to a peer-reviewed journal for publication.

Protocol registration number

INPLASY2021120040.

Clinical educators can supervise students without increased stress: a study of interacting factors using insights from complexity theory

Supervising students in healthcare settings is complex and can be stressful for clinical educators. However, it is unclear how to design student placements without clinical educator stress. Using complexity theory as a lens, fuzzy set Qualitative Comparative Analysis (fsQCA) was used to explore factors associated with no increased stress for clinical educators during speech pathology (SP) placements. Factor selection was informed by the Demand- Control- Support model and existing literature. No single factor was necessary for clinical educators to experience no increased stress. Varied combinations of all factors were found in 10 paths to no increased stress. These combinations often had passing student(s); however, multiple paths included other factors that could be adjusted by clinical educators prior to placement. For example, having more than one workday per week without students was a factor in four paths to no increased stress despite other potential challenges such as a higher caseload throughput. More experienced educators, who had other supporting factors (e.g. lower caseload throughput or workplace engagement such as support from colleagues and managers), also perceived no increased stress in four paths. Student placements without increased stress for clinical educators require consideration of multiple interacting factors. Principles of complexity theory provide insight into how clinical educators uniquely respond to their individual circumstances, resulting in different experiences of student placement impact even within similar workplaces. FsQCA has highlighted practical ways clinical educators supervise students without increased stress. However, any changes for an individual clinical educator need to be considered in combination with other factors given the complexity of clinical education and healthcare settings.

Podoconiosis instruction at nursing schools in Kenya, Rwanda, and Uganda

BACKGROUND

Podoconiosis is a preventable, progressive, and non-infectious form of elephantiasis that can contribute to significant disability and economic burden when not treated early. Nurses play a critical role in early detection and response in rural Africa, but it is unclear if they receive adequate training on podoconiosis. We aimed to characterize podoconiosis instruction at all government accredited, post-secondary nursing institutions in three African countries.

METHODS

Data for this cross-sectional study was collected through a quantitative survey with several open-answer questions. Through a rigorous online search, we identified all post-secondary institutions in Kenya, Rwanda and Uganda accredited to teach human nursing. A total of 289 accredited programs, including 85 certificate, 56 degree and 148 diploma programs were invited to participate. Respondents completed surveys online or by telephone. Measures focused on podoconiosis knowledge, perceptions of quality/quantity of podoconiosis instruction, and barriers to sufficient podoconiosis education.

RESULTS

We obtained information about 212 curricula across 149 nursing institutions in the three countries (participation rate: 73.4%). Podoconiosis coverage was limited across programs (certificate-24.1%; diploma-55.6%; degree-30.3%). Most respondents felt that the quality and quantity of instruction were insufficient (60.6%, 62.9%), respectively. Exclusion from government curricula, low priority and faculty lack of knowledge were commonly reported barriers to podoconiosis inclusion.

CONCLUSIONS

This study demonstrated clear gaps in podoconiosis training for nurses across the three countries and highlights a serious challenge in eliminating podoconiosis as a public health problem. Interventions to improve nurses' knowledge could include the development and free distribution of podoconiosis teaching materials, designed for integration into pre-existing courses.

Are internship experiences during a pandemic related to students' commitment to nursing education? A cross-sectional study

BACKGROUND

The predominate role of internships on the retention of nursing students highlights the need to monitor internship experiences during a healthcare crisis like CoViD-19.

OBJECTIVES

To explore the relation between internships experiences during a pandemic and student nurses' commitment or intention-to-leave the nursing program; as well as the relation between internship experiences and commitment or intention-to-leave the nursing program.

DESIGN, SETTING AND PARTICIPANTS

A cross-sectional study using a sample of 1.079 nursing students from18 nursing schools in Flanders, Belgium. Students from all study years were eligible to participate.

METHODS

Online self-reporting survey during the first CoViD-19 wave (April-May 2020). Regression analyses were used to explore the association with students' commitment or intention-to-leave.

RESULTS

Students reported high levels of study commitment (4.06; SD 0.66; range 1-5), and an overall low intention-to-leave (1.64; SD 0.83; range 1-5). No difference in commitment or intention-to-leave were seen between students who did or did not had internship experience during CoViD-19 period. Need-supportive experiences - indicating that students felt competent, related to the team, and could be themselves on internship - coincided with high commitment. Conversely, need-frustrating experiences - indicating that students felt insecure, unrelated, and controlled by the nursing team - increased intention-to-leave nursing education. Students who felt pressured for an internship during the first wave of the CoViD-19 crisis, had more doubts to continue nursing education, and an increased chance on drop-out.

CONCLUSIONS

We recommend nursing schools to assess student's motivation when making a substantiated decision concerning internships during a health crisis, as facing an imposed or subjective mandatory decision to go into clinical practice might lead to less commitment to the study program. For both teacher and staff mentors it is deemed important to discuss the internship climate with the student, in order to early identify need-frustrating issues during internship.

What Helps, What Hinders? Undergraduate Nursing Students' Perceptions of Clinical Placements Based on a Thematic Synthesis of Literature

Introduction

Clinical placements are a mandatory component of nursing students’ education internationally. Despite clinical education being a key to nursing students’ achievement of nursing competencies, few studies have reviewed students’ narratives to describe their experiences of learning during clinical placement. Such studies may be important in offering a deeper insight into clinical learning experiences than quantitative surveys.

Methods

A systematic thematic synthesis of qualitative studies between 2010 and June 2020 was conducted. English language studies that offered a thematic analysis of undergraduate nursing students’ experiences of learning during placement were sought. A search was made of five databases PubMed, Ovid Medline, CinahlPlus, SCOPUS, and Google Scholar. The study was guided by the ENTREQ statement for enhancing transparency in reporting the synthesis of qualitative research.

Results

Twenty-seven qualitative studies were included in the review. A thematic synthesis showed over 100 themes and subthemes across the studies. A cluster analysis revealed positive elements and others that were seen in the studies as a barrier (hindrance) to clinical learning. Positive elements included supportive instructors, close supervision, and belonging (in the team). Unsupportive instructors, a lack of supervision and not being included were seen as a hindrance. Three key overarching themes that could describe a successful placement were revealed as “Preparation,” “Welcomed and wanted” and “Supervision experiences”. A conceptual model of clinical placement elements conducive to nursing students’ learning was developed to enhance understanding of the complexities associated with supervision. The findings and model are presented and discussed.

Conclusion

The conceptual model presents positive elements that influence students’ clinical placement experiences of learning. This model may provide a framework to guide professional development programs and strategies to support students and supervisors alike, an important step forward in moving beyond the current clinical placement rhetoric.

Conceptions of clinical learning among stakeholders involved in undergraduate nursing education: a phenomenographic study

BACKGROUND

To prepare nursing students to become critical, autonomous members of the workforce, an agreement among stakeholders on how this can be achieved in the clinical setting is needed. However, a critical discussion of the clinical learning process in relation to actual and desirable outcomes is lacking in the nursing education literature. This study aimed to map conceptions of the desired process and outcomes of clinical learning among stakeholders involved in undergraduate clinical nursing education.

METHODS

Twenty-five semi-structured interviews about their understanding of clinical learning were conducted with nursing students, supervisors, clinical educators and higher education institute professionals involved in clinical nursing education in a Dutch academic medical center. Data were analyzed using a phenomenographic approach.

RESULTS

Four conceptions were identified: clinical learning as a process to 1) meet curricular demands, 2) learn to deliberately deliver patient care, 3) learn to deliver patient care within the larger (healthcare) context, and 4) become a continuously developing professional. Conceptions 3 and 4 represented a broader, more inclusive perspective on clinical learning than conception 1 and 2. Conceptions were distinguished by five dimensions: role of guidelines from the school; learning opportunities, focus of supervisor; focus of reflection; desirable outcomes of clinical learning.

CONCLUSIONS

Those directly involved in clinical learning in nursing may have qualitatively different understandings of its desired nature and outcomes. Two patterns across conceptions could be discerned: a) a shift in focus from learning as following standards, to following an individualized learning trajectory and b) a shift in focus from increasing patient load, to understanding oneself and the patient within the healthcare context. To prepare nursing students for the future workforce, a flexible, social form of self-regulated learning is warranted, as well as an understanding of one's own role within the healthcare system and a critical attitude towards healthcare. Schools and hospitals should collaborate to integrate these values in the curriculum. The current study adds different ways of applying self-regulated learning as a relevant dimension in understanding clinical learning to the literature. Through the phenomenographic approach we identified conceptions that can be a basis for training and policy development.

Psychometric properities of the Polish version of clinical learning environment inventory

Background

Clinical experience is a crucial activity for nursing students. The way students` perceive clinical placement exerts an immense influence on the learning process. This study aims to test the psychometric properties of a 19-item version of the Clinical Learning Environment Inventory under Polish clinical conditions.

Method

For this study, Discriminant validity and Cronbach’s alpha reliabilities were computed. In order to measure content validity, the criterion validity Generalized Self Efficacy Scale and the Life Orientation Test - Revised were used.

Results

Cronbach’s Alpha for the Clinical Facilitator Support of Learning Scale and the Satisfaction with Clinical Placement scale is 0.949 and 0.901, respectively. The Spearman’s rank correlation coefficient indicates the existence of a positive correlation between the students’ satisfaction with clinical placement and their [overall] life optimism. Age correlates negatively with perceived teacher support and positively with satisfaction with clinical placement. The sense of self-efficacy correlates negatively with their satisfaction with clinical placement. Clinical Learning Environment Inventory − 19 could be a useful tool to evaluate the quality of the clinical learning process in Polish conditions.

Learning Experience of Chinese Nursing Students during Clinical Practicum: A Descriptive Qualitative Study

The change in clinical environment can have a significant impact on nursing students’ clinical learning and as a consequence, to their competency. Students’ learning experiences could provide important insights for improving the existing approach towards clinical education. This descriptive qualitative study aimed to explore nursing students’ clinical learning experience. Focus group interviews were conducted with 20 final year nursing students studying a bachelor nursing programme at a self-financing tertiary institution in Hong Kong. Thematic analysis was conducted. 16 female and four male students were recruited. Six themes were identified: Anxiety towards clinical practicum, expectations of roles and responsibilities in practicum, ward environment, adequacy of support, learning attitude, and practicum arrangement. The findings suggest that nursing students are more discontented with their clinical training than before. Nursing faculty must look for possible ways to improve the clinical learning environment.

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.

Contribution of students to nursing practice settings during clinical training: Design and validation of a questionnaire

BACKGROUND

A validated questionnaire to measure the contributions of nursing students to clinical settings could potentially assist in the improved management of students in healthcare institutions.

AIM

To develop and test the psychometric properties of the questionnaire 'Nursing Student Contributions to Clinical Settings' (CEEEC, Spanish acronym for 'Contribuciones de los Estudiantes de Enfermería a los Entornos Clínicos').

DESIGN

Instrument design and psychometric testing.

PARTICIPANTS/SETTINGS

A multicentre study involving 1,098 nursing professionals from three universities and five hospitals of Spain, between January 2019 and March 2020.

METHODS

The study was carried out in two phases. Phase 1 involved the questionnaire design by experts (n = 28), which required a review of the available literature, cognitive interviews and Delphi rounds, and a preliminary validity study, which included a pilot test with responses from a sample of nurses (n = 143). Phase 2 involved a formal validation with a wider sample of nurses (n = 927), including factor analysis and a study of convergent validity with the Practice Environment Scale-Nursing Work Index and Health Sciences-Evidence Based Practice.

RESULTS

Experts selected 42 items on student contributions. After cognitive interviews, three items were eliminated and seven failed to reach the minimum content validity index (78%). Based on the remaining 32 items, the discrimination index of each item was calculated, and those with <0.3, eight items were sequentially eliminated. The resulting questionnaire contained 24 items grouped into a single factor, which explained 41% of the variance. The internal consistency was excellent (Cronbach's alpha: 0.94), and the convergent validity was confirmed.

CONCLUSIONS

A 24-item questionnaire was designed and validated to measure the contributions of nursing students to clinical practice settings.

IMPACT

Most hospitals are also teaching centres where nursing students undergo clinical practice. The application of this test will provide insight into the nursing professionals' perception of the students' role.

Nursing students' experiences with clinical placement in residential aged care facilities: a systematic review of qualitative evidence

OBJECTIVE

The objective of this systematic review was to synthesize the best available evidence on nursing students' experiences with clinical placement in residential aged care facilities.

INTRODUCTION

Nursing education programs play a key role in preparing future nurses to care for the growing number of older adults who will require health care. A key component of this preparation involves ensuring that curricula optimize student learning through carefully designed clinical learning practice experiences. Residential aged care facilities provide students with opportunities to work exclusively with older adults. Studies that address clinical placements in residential aged care facilities highlight both the benefits and concerns of student learning and professional development. Insight into student experiences of clinical placements in residential aged care facilities can help inform nursing curricula and contribute to a better understanding of how best to prepare students to care for an aging population.

INCLUSION CRITERIA

This review considered all qualitative studies that included undergraduate and diploma nursing students. Nursing students included individuals or groups identified as nursing students independent of the type of program, level of learning, or time spent in the setting.

METHODS

A three-step search strategy was used to identify English language qualitative primary research studies. Two reviewers independently appraised the included studies using the JBI Critical Appraisal Checklist for Qualitative Research. Key findings were extracted and classified as unequivocal or credible.

RESULTS

Fourteen qualitative studies were included, published between 2003 and 2018. A total of 53 findings were extracted and aggregated into seven categories. From the seven categories, two synthesized findings were developed: the evolution of learning and embracing opportunity.

CONCLUSION

This review captured student experiences of clinical placement in residential aged care facilities. The findings highlight the importance of students entering the setting with knowledge of how to care for older adults and being able to respond to challenging resident behavior. Equally important is the need for students to understand the roles and contributions of all care staff in the setting, including nurses and unregulated care providers. Although the residential aged care setting can be a challenging learning environment for students, it also offers opportunities for student growth and professional development, especially when there are clearly articulated learning outcomes and appropriate role models available.

Challenges in the assessment of nursing students in clinical placements: Exploring perceptions among nurse mentors

AIM

The aim was to explore how nurse mentors experience the assessment of nursing students in clinical placements at hospitals and in municipal health care.

DESIGN

The study is qualitative with an explorative and descriptive design.

METHODS

Based on an interview guide, we conducted 19 individual qualitative interviews and four focus group interviews with nurse mentors from various levels and fields of nursing education at a Norwegian university.

RESULTS

Feedback in and on action was an integrated part of the formative assessment. In the summative assessment, where the university lecturer also participates, the nurse mentors perceived their role as passive. A disturbing finding was that divergent views on the student's competence sometimes occurred in these situations, thus challenging the credibility of the student assessment. Perceptions of nursing values and concerns embedded in nursing practice as collective criteria appear to have an impact on the mentors' assessment of the nursing students.

Applying the social cognitive model of well-being in the nursing clinical practicum: A structural equation modeling analysis with a Spanish student's sample

BACKGROUND

Clinical education, understanding as practicum, plays a key role in nursing education but has been identified as the most challenging and stressful experience for nursing students. Promoting student satisfaction and well-being during clinical practice has a significant effect on learning outcomes, retention and attrition.

OBJECTIVES

To examine the predictive power of a social cognitive model of wellbeing when applied to explain academic satisfaction in the clinical practicum and overall life satisfaction of Spanish nursing students.

DESIGN/PARTICIPANTS

A cross-sectional correlational study was conducted at four Spanish nursing schools in a 586 student's sample.

METHODS

Data were collected through a self-reported questionnaire that included measures of academic support, self-efficacy, goal progress, academic satisfaction, life satisfaction and trait positive affect. The research model was evaluated through structural equation modeling.

RESULTS

The proposed model fit well in the full sample and accounted for substantial portions of the variance in academic (50%) and life satisfaction (21%). Most of the hypotheses formulated were verified. The model was invariant across academic year.

CONCLUSIONS

The results indicated global support for the social cognitive model of academic satisfaction as a guide for developing interventions to facilitate the positive adjustment and wellbeing of nursing students in the practicum.

A predictive model of student nursing competency in clinical practicum: A structural equation modelling approach

BACKGROUND

Clinical teaching is the most important element in the development of students' nursing competencies. However, students' learning modalities in clinical settings are unclear.

OBJECTIVE

To analyse path relationships affecting students' learning outcomes in clinical practicum using LISREL software.

DESIGN

A cross-sectional survey was administered.

SETTINGS AND PARTICIPANTS

Participants were 392 senior students who had completed their final internship recruited from two nursing programmes in central Taiwan.

METHODS

Administration and completion of the following structured questionnaires: the Competency Inventory of Nursing Students, the Teaching Competence of Nurse Preceptor questionnaire, the Student Evaluation of the Clinical Education Environment, Level of Reflective Thinking, and the Metacognitive Inventory for Nursing Students.

RESULTS

The results suggested that teaching competence may indirectly affect nursing competence through metacognition and reflection. The clinical learning environment may directly affect nursing competence or indirectly affect nursing competence through metacognition. Both metacognition and reflection have direct effects on nursing competence, and reflection exerts indirect effects on nursing competence through metacognition. The path relationships differed according to the employment plan group.

CONCLUSIONS

Reflection and metacognition are essential skills for the development of nursing competence in clinical settings. Clinical instructors must facilitate student learning by fostering a positive learning environment and teach students the reflective and self-regulation skills necessary to achieve favourable learning outcomes in clinical settings.

Hofstede's cultural dimensions as the explanatory framework for performance issues during clinical placement: A mixed methods study

AIMS AND OBJECTIVES

The objectives of this study were to examine a) if those with reported clinical performance issues were more likely to experience course progression issues or withdrew from the program; b) the relationship between clinical and academic performance; c) the relationship between students social-demographic characteristics and clinical performance issues; and d) the utility of Hofstede's cultural dimensions theory in explaining the clinical performance issues students may experience during clinical placement.

METHOD

Retrospective textual reports of clinical issues from 2014 to 2018 were collected. A mixed methods design, particularly Embedded Design, was used. The qualitative data was analysed using Directed Content Analysis using Hofstede's six dimensions as the coding categories, which were further broken down into high and low poles, making a total of 12 subcategories. Univariate and multivariate logistic regression was utilised to analyse the quantitative data.

RESULTS

Using Hofstede's framework, it was determined that nursing students 21 years and younger were more likely to have issues related to low long-term orientation. Male students were more likely to have issues related to low uncertainty avoidance and also displayed masculinity related issues. Overseas-born students were less likely to experience issues related to low power distance and students that had not failed a unit of study were less likely to have issues related to low long-term orientation. The study also found that students experienced issues related to poor psychomotor skills and language barriers. Furthermore, the study identified that students who experienced clinical placement issues were three times more likely to leave the course.

CONCLUSION

Hofstede's cultural dimensions framework can be used to explain clinical performance issues among undergraduate nursing students. Early identification of the students likely to experience these issues can lead to targeted and preventative interventions.

Nursing students' views and satisfaction of their clinical learning environment in Singapore

Aims

This study aims to investigate final-year nursing students' actual perception of their clinical learning environment in Singapore.

Design

Descriptive cross-sectional survey.

Methods

An online survey based on the clinical learning environment inventory (CLEI; "Actual" version) was administered to final-year (third year) nursing students (N = 301) in a polytechnic in Singapore between May-July 2018.

Results

Most nursing students reported moderate satisfaction with their clinical learning environment, reflecting their positive (although not strongly positive) perceptions. Among the six constructs of the CLEI, the higher scores of the constructs of "Personalization" and "Task orientation" implied their greater contribution to the positive view. Conversely, the lower scores of "Individualization" and "Innovation" implied their lesser contribution. Additionally, the positive correlation between "satisfaction" and the other five CLEI constructs was found to be statistically significant.

Educating generation Z: Psychosocial dimensions of the clinical learning environment that predict student satisfaction

Generation Z (Gen Z) nursing students have characteristics that differentiate them from previous cohorts. They are entrenched in technology, prefer to work at their own pace, seek a great deal of feedback, and can be anxious. Because Gen Z is also entrepreneurial, it is important to identify strategies for promoting satisfaction among Gen Z nursing students to retain them in nursing. This study sought to identify the psychosocial dimensions of the clinical learning environment that best predict Gen Z nursing student satisfaction in the medical-surgical clinical learning environment. A secondary analysis was performed on data collected using the Revised Clinical Learning Environment Inventory-32. Maximum Likelihood regression analysis identified predictors of satisfaction. Three subscales of the CLEI-32, reflecting 3 psychosocial dimensions of the clinical learning environment, significantly predicted student satisfaction in the clinical learning environment, after controlling for clustering effects of students within hospitals. Findings were consistent with the literature on Gen Z learners and revealed that their satisfaction improves when they can make decisions, work at their own pace, and receive direction, feedback, and support. The effect of hospital environment on the clinical learning environment should be investigated further; other variables that predict satisfaction remain to be identified.

Nursing and midwifery students' experiences and perception of their clinical learning environment in Malawi: a mixed-method study

Background

The clinical learning environment is an important part of the nursing and midwifery training as it helps students to integrate theory into clinical practice. However, not all clinical learning environments foster positive learning. This study aimed to assess the student nurses and midwives' experiences and perception of the clinical learning environment in Malawi.

Methods

A concurrent triangulation mixed methods research design was used to collect data from nursing and midwifery students. Quantitative data were collected using a Clinical Learning Environment Inventory, while qualitative data were collected using focus group discussions. The Clinical Learning Environment Inventory has six subscales of satisfaction, involvement, individualisation, innovation, task orientation and personalisation. The focus group interview guide had questions about clinical learning, supervision, assessment, communication and resources. Quantitative data were analysed by independent t-test and multivariate linear regression and qualitative data were thematically analysed.

Results

A total of 126 participants completed the questionnaire and 30 students participated in three focus group discussions. Satisfaction subscale had the highest mean score (M = 26.93, SD = 4.82) while individualisation had the lowest mean score (M = 18.01, SD =3.50). Multiple linear regression analysis showed a statistically significant association between satisfaction with clinical learning environment and personalization (β = 0.50, p = < 0.001), and task orientation (β =0.16 p = < 0.05). Teaching and learning resources, hostile environment, poor relationship with a qualified staff, absence of clinical supervisors, and lack of resources were some of the challenges faced by students in their clinical learning environment.

Conclusion

Although satisfaction with clinical learning environment subscale had the highest mean score, nursing and midwifery students encountered multifaceted challenges such as lack of resources, poor relationship with staff and a lack of support from clinical teachers that negatively impacted on their clinical learning experiences. Training institutions and hospitals need to work together to find means of addressing the challenges by among others providing resources to students during clinical placement.

Fourth year nursing students' perceptions of their educational preparation in medication management: An interpretative phenomenological study

BACKGROUND

Medication safety is an integral aspect of patient safety. Nurses, as advocates of patient safety, actively consider medication safety in the course of their daily work. Hence, it is important to consider the educational preparation of nursing students in medication management, as future caregivers. There are inherent links between nurses' undergraduate educational preparation in medication management and patient safety.

OBJECTIVE

This research study identifies fourth-year nursing students' perceptions of their educational preparation in medication management.

DESIGN

An interpretative phenomenological methodological approach underpinned this research study.

SETTING

This study was conducted at a University in the West of Ireland.

PARTICIPANTS

Participants were final year students of three undergraduate nursing programmes, Bachelor of Science in Nursing (General), Bachelor of Science in Nursing (Intellectual Disability) and Bachelor of Science in Nursing (Mental Health).

METHODS

Fourteen semi-structured, face-to-face interviews were conducted with students on a one-to-one basis. Data were analysed using thematic content analysis.

RESULTS

The voices and interpretations of the participants in this study were fundamental to understanding nursing students' perceptions of their preparation in medication management and provided the foundation for this research. These perceptions were captured in the format of four themes: developing an understanding, embedding knowledge in practice, engaging in practice and accepting professional responsibility.

CONCLUSIONS

Findings point to the important role of the university and the clinical placement settings in nursing students' medication management education and the need for further collaboration and development across both settings. Teaching and learning strategies which promote the integration of theory and practice throughout the four years of the undergraduate degree programme should be encouraged, such as technology enhanced learning and simulation.

Student beliefs about their practice within a non-traditional mental health clinical placement

Therapeutic recreation programs utilize leisure to maximize a person's overall health and well-being. The focus of this study is a professional experience placement held within an outdoor recreation center involving student nurses and people with a lived experience of mental illness. The study aimed to explore student nurse's beliefs about their practice within the program setting. An ethnographic case study approach was used to focus on the development of student nurse practice in this setting. The analytic strategy derived the themes of the ethnographic case study, namely 'who's who', 'clinical contrast' and 'recreation as practice'. A non-traditional mental health clinical placement would seem to have the potential in providing a new set of skills and experiences to these future nurses that may complement the scope of recovery-orientated care. The therapeutic recreation program provided the student with an experience where they could develop therapeutic relationships with people a lived experience of mental illness.

Graduating midwifery students' preferred model of practice and first job decisions: A qualitative study

OBJECTIVES

To explore and describe the preferred model of practice and first job decisions of final stage midwifery students from three Western Australian universities.

DESIGN

Qualitative descriptive.

SETTING

Three Western Australian (WA) universities offering courses leading to registration as a midwife.

PARTICIPANTS

Twenty-seven midwifery students from undergraduate and postgraduate (pre-registration) courses.

METHODS

Data were collected from recorded interviews and focus groups. Thematic analysis of interview transcripts was used to identify commonalities. Data saturation guided when recruitment ceased and final sample size was achieved.

FINDINGS

Participants' preferred model of maternity care was influenced by learning about and witnessing both autonomous midwifery practice and collaborative care during their studies. The greatest influence was clinical experience, with most preferring a continuity of midwifery model (CoM) but first consolidating their practice in a public hospital. Most students reported that they would not choose a private hospital as their first option. Work/life balance was also considered, with some accepting that family commitments and a need to work close to home may prevent them from choosing a CoM model.

CONCLUSION AND IMPLICATIONS

Although many Australian midwifery students start their midwifery course with preconceived ideology of their eventual workplace, the influences of their educators, clinical placement environment, preceptors and continuity of care experience relationships with women helped determine their final direction. To provide students with the experiences to become woman-centred autonomous practitioners it is important for universities and all maternity care providers to carefully consider their responsibility in how they influence midwifery students in education and practice.

Impact of a work-based feedback intervention on student performance during clinical placements in acute-care healthcare settings: a quasi-experimental protocol for the REMARK programme

INTRODUCTION

Current perspectives present feedback as a dynamic, dialogic process. It is widely accepted that feedback can have an impact on workplace performance, however, how dialogic feedback is enacted with the learner in authentic healthcare settings is less apparent. This paper seeks to describe the design and development of an implementation study to promote the learner voice in the feedback process and improve feedback encounters between learners and learning partners in healthcare settings.

METHODS AND ANALYSIS

A quasi-experimental study design will be used to evaluate whether implementation of a work-based intervention to improve feedback impacts student performance during clinical placements in healthcare settings. Student performance will be measured at three time points: baseline (pre), mid-placement (post-test 1) and end-placement (post-test 2) in keeping with standard assessment processes of the participating university. The intervention is underpinned by Normalisation Process Theory and involves a layered design that targets learners and learning partners using best-practice education strategies. Data regarding participants' engagement with feedback during clinical placements and participants' level of adoption of the intervention will be collected at the completion of the clinical placement period.

ETHICS AND DISSEMINATION

This study has ethics approval from both Griffith University and Metro South Health Human Research and Ethics committees. Dissemination of results will be local, national and international through forums, seminars, conferences and publications.

Nursing students' perceptions of clinical learning opportunities and competence in administration of oral medication in the Western Cape

BACKGROUND

Medication errors may result in patients' harm and even death. The improvement of nursing students' competence in the administration of medication through education and training can contribute to the reduction of medication errors.

OBJECTIVES

This study aimed at describing the Bachelor of Nursing students' perceptions about clinical learning opportunities and competence in the administration of oral medication.

METHOD

A quantitative descriptive design was employed. An all-inclusive sample of 176 nursing students registered at a university in the Western Cape, South Africa, in 2014 was considered for the study, of whom 125 students consented to participate and completed the questionnaires. Statistical Package for the Social Sciences (SPSS) version 22 was used for data analysis and descriptive statistics were conducted.

RESULTS

The findings showed that a minority of students did not have opportunities to rotate in all specific types of wards. The findings indicated that a total of 92% (115) and 86.4% (108) of the 125 respondents were placed in medical and surgical wards, respectively, where they more likely had opportunities to practise the administration of oral medication. However, 59.2% (74) did not practise administration of oral medication on a daily basis. Only 19.2% (24) of respondents perceived themselves as competent in the administration of oral medication.

CONCLUSION

The findings indicated that many students perceived their education and training as not providing sufficient learning opportunities to practise the administration of oral medication, whilst the majority of respondents perceived themselves as competent in some of the aspects related to the administration of oral medication, and very few perceived themselves as competent overall in the administration of oral medication.

Preceptors´ experiences of student supervision in the emergency medical services: A qualitative interview study

BACKGROUND

Clinical placements play a central part in the education of future emergency medical services (EMS) staff and their development of clinical skills and competence. A key aspect of students' integration of theory and praxis and development into an independent clinician is a supportive mentorship with the preceptor. However, students report barriers for learning within the EMS, while the preceptors' experiences of their role have received scant attention in research.

OBJECTIVES

To describe preceptors' experiences of student supervision in the EMS during clinical placements.

DESIGN

A descriptive qualitative design was used. Twenty specialist nurses were recruited among EMS staff from all parts of Sweden.

METHODS

Data were collected using individual interviews and analyzed with latent qualitative content analysis.

FINDINGS

EMS preceptors develop a competence in combining caring and learning adapted to individual student needs when facing students with varying needs in an ever-changing healthcare setting. A trustful relationship between student and preceptor is fundamental when coping with a dual responsibility for student and patient needs. However, several aspects in the EMS setting hinders the preceptors' ability to support the development of the students' independence. Surrounding support structures are important if the preceptors are to feel safe and secure in their role as assessor, teacher and ambulance nurse.

CONCLUSIONS

Preceptors need to develop a didactic flexibility through preceptor courses adapted to the complex premises found in the EMS. Ambulance services and universities should recognize the importance of preceptors´ colleagues, student continuity, university support and cooperation for improving quality and clarity in supervision during clinical placements.

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.

Jordanian Nursing Student and Instructor Perceptions of the Clinical Learning Environment

Background Training within clinical areas is a vital part of nursing education. In order to effectively modify and facilitate such training, it is important to understand the perceptions of nursing educators and students about what constitutes effective practices.

OBJECTIVE

This study explores perceptions of Jordanian nursing students and clinical instructors related to clinical training and the learning environment.

DESIGN

Interpretative phenomenological qualitative approach was used in this study.

METHOD

semi-structured focus group interviews in two Jordanian Universities Results: The study identified four themes focused on the experiences of these participants. Themes were attributes of clinical training placement, attributes of clinical instructors, attributes of clinical nursing curriculum and student's attributes. The first theme had two subthemes "Structure and nature of clinical placement" and "Nurses' collaboration".

CONCLUSION

The study recommendations are: nursing schools should plan students' clinical experience taking into consideration the challenges associated with these attributes.

Nursing students' experiences of nurse teacher mentoring and beneficial digital technologies in a clinical practice setting

Due to educational reforms in Finland, the nurse teacher's role is being reduced in mentoring of nursing students in the clinical practice. Students reported experiencing a lack of instruction and feeling abandoned in the clinical practice. The aim of this study was to describe nursing student experiences of mentoring by nurse teachers in clinical practice, as well as the benefits of digital technology in this context. Qualitative study design was used with semi-structured focus group interviews. Nursing students (n = 15) who had completed at least one clinical placement during their nursing education. Data were collected in autumn 2017 from two universities of applied sciences in northern Finland. The data were analyzed using inductive content analysis. Mentoring by nurse teacher was perceived as a key part of learning evaluation, integrating theoretical and practical knowledge, understanding the student's role and emotional support. The results also revealed that mentoring can be improved by using digital technology. However, technology cannot completely replace face-to-face mentoring. The mentoring provided by nurse teachers plays an important role in the success of a nursing student's clinical practice. Digital technology can be leveraged to enhance the learning experience when easy-to-use and ubiquitous applications are integrated into the clinical learning setting.

Student perceptions of knowledge development and consolidation in a clinical community of practice

The undergraduate nursing degree in the UK comprises both theoretical and practical elements with the practical component being a large and important aspect. Within the clinical environment students learn to become a nurse by gaining membership of a community of practice and learning the technicalities of nursing. As the future of health and social care looks set to see unprecedented changes, contemporary nursing practice will demand that nurse graduates are equipped with advanced knowledge and skills. By doing so, graduate nurses will go on to provide high quality care within this changing context. The aim of the research was to explore student nurse perceptions of knowledge development and consolidation in a clinical practice environment by utilising a community of practice theoretical framework to question whether the clinical community of practice prepares student nurses for contemporary nursing practice. Four themes emerged from the research: establishing a place in the community, shaping identity, initiating learning opportunities, preparation for future practice. The findings suggest that the clinical community of practice provides an opportunity for students to both learn the technicalities of nursing and develop their professional identity. However, whilst the learning environment may be functional in maintaining current practice, it may not facilitate the learning required for contemporary nursing practice.

Evaluating the learning environment of nursing students: A multisite cross-sectional study

BACKGROUND

Identifying students' experiences of the university and clinical learning environments informs quality improvement of courses.

OBJECTIVES

To investigate undergraduate nursing students' perceptions of their education environment and the facilitators and barriers to learning, during university and clinical experiences.

DESIGN

Multi-site cross-sectional survey.

SETTING

Four universities in Vietnam.

PARTICIPANTS

Undergraduate nursing students (n = 891).

METHODS

Between May and August 2016, Vietnamese versions of the Dundee Ready Education Environment Measure (Nursing) and the modified Clinical Learning Environment Inventory measured students' perceptions of university and clinical environments respectively. Two additional open-ended questions elicited perceptions of facilitators and/or barriers to clinical learning.

RESULTS

The university environment was rated as needing improvement and significant differences between universities and year of study detected. University environment mean scores were significantly higher in second year students compared with those in the third or fourth years of study. Active teaching and interpersonal relationships at university were rated positively. Overall, clinical environment scores were mid-range and second year students' mean scores were significantly higher than third or fourth years. Clinical placements greater than four weeks duration had significantly higher mean score than two week placements.

CONCLUSIONS

Evaluation of university and clinical experiences assists with identifying potential areas of interruption to nursing students' transfer of learning. In both learning environments, Vietnamese students' experiences were similar to those experienced in Western countries in that interpersonal relationships with teachers and ward staff were key factors perceived to influence learning. A notable difference in this study was the hospital environment in Vietnam had features unique to this country that interrupted students' transfer of learning. Globally it is a priority for nurse educators to facilitate both on and off campus environments that promote students' learning. Assessing these environments is a useful strategy for quality improvement of courses.

Evidence-based practice integration in hospital wards-The complexities and challenges in achieving evidence-based practice in clinical nursing

AIM

Exploring the processes involved in two different strategies to integrate evidence-based practice into nursing practice.

DESIGN

Classical grounded theory methodology was used.

METHODS

Data were collected through 90 hr of observation and 4 focus groups among clinical nurses in two different hospital wards.

RESULTS

We identified a multidimensional evidence-based practice integration framework that illuminates the complexities involved in the integration process. The dimensions were approaches to evidence-based practice, positions of evidence-based practice and levels of evidence-based practice. The interactions between the dimensions gave five combinations; an explicit evidence-based practice performed as a parallel to daily work at the systems level, an implicit evidence-based practice integrated into daily work at the systems level, an explicit evidence-based practice integrated into daily work at the individual level, an explicit evidence-based practice integrated into daily work at the systems level and an implicit evidence-based practice integrated into daily work at the individual level.

Assessing nursing students' knowledge of evidence-based guidelines on the management of peripheral venous catheters: A multicentre cross-sectional study

BACKGROUND

Inserting Peripheral Venous Catheters (PVCs) is one of the most routinely performed invasive procedures in nursing care and, if not well managed, it could expose patients to bloodstream-related infections. Knowledge of guidelines for the management of PVCs is fundamental to arise nurses and nursing students (NSs)' awareness on the importance of recommendations' adherence for clinical practice improvement.

OBJECTIVE

To determine NSs' theoretical knowledge of evidence-based guidelines for management of PVCs and investigate potential predictive factors associated to recommendations' adherence.

DESIGN

Cross-sectional.

SETTINGS

The study was carried out (March-September 2015) in seven Universities of three Regions of Italy (Marche, Abruzzo, Emilia Romagna).

PARTICIPANTS

A convenience sample of NSs (n = 1056) was involved.

METHODS

We collected data using a 10-items validated questionnaire assessing: knowledge of NSs' PVC guidelines and socio-demographic characteristics of the sample.

RESULTS

Most participants were female (74.8%), mean age: 22.4 years (DS = 3.9); attending the first, second and third year of Bachelor in Nursing (34.8%; 32.9%; 32.3%, respectively); with at least one year of training experience (32.1%). Most of incorrect answers given by NSs concerned the right way to wash hands before CVPs insertion (33.5%); the replacement of administration set <24 h when neither lipid emulsions nor blood products have been infused (79.7%); the choice of dressing to cover insertion site (59.3%); the use of steel needles to administer drugs (60.9%); the use of antibiotic ointment (68.7%); the correct concentration of chlorhexidine before PVCs' insertion (70.7%). In multivariate analysis, a higher level of education and an increased number of years of training experience and wards attended, were associated with better test scores. "Infusionset removal after 24 h when lipids or blood products are administered" (75.4%).

CONCLUSIONS

NSs' overall level of knowledge to some recommendations is inadequate. Nurse educators should emphasize on the importance of Evidence-based guidelines' knowledge in order to promote the translation of theory into practice of NSs.

Altered nursing student perspectives: Impact of a pre-clinical observation experience at an outpatient oncology setting

This study examined the influence of an observation experience at an outpatient oncology setting on first-year nursing students. This experiential learning opportunity occurred prior to any formal clinical practice course. A hermeneutic phenomenology approach was used to uncover pre-licensure nursing students' perspectives about cancer, as well as their understanding of the roles and responsibilities of registered nurses in cancer care both before and following their experience. A total of 10 nursing students agreed to participate in the study. Data were collected through semi-structured interviews following which data were analyzed and interpreted to understand the meaning in the experience. Two overarching themes were identified including circles of relationships, and the many sides of outpatient oncology. This study reveals that experiential learning in the form of a low-risk, observation-only experience may be an opportunity for pre-licensure students to gain new perspectives about cancer care and nurses roles in caring for individuals and families who are impacted by cancer.

Clinical placement experiences by undergraduate nursing students in selected teaching hospitals in Ghana

Background

In meeting the global standard of patient safety, quality care and nursing leadership, countries are urged by the World Health Organisation to have a greater proportion of nurses educated to degree level or higher. However, some researchers have found that there are very little differences in competencies of diploma registered nurses and first degree nurses in some countries. University education in nursing remains problematic and there are many disparities in the programmes currently being offered in different parts of the world. Though teaching hospitals in Ghana are expected to assist in the training of undergraduate nursing students, there is limited scientific evidence on experiences of undergraduate nursing students in these teaching hospital environments. The purpose of this study was to explore the experiences of undergraduate nursing students in selected teaching hospitals in Ghana.

Methods

A qualitative explorative descriptive design was used in conducting the study. Purposive sampling technique was utilised in collecting data from thirty-five undergraduate nursing students placed in two teaching hospitals in Ghana. Data were collected through a semi-structured interview guide and analysed manually by the research team. A thematic content analysis was used in analysing data.

Results

Four main categories of themes were extracted from data. These themes were: 1. Feeling isolated in clinical placement. 2. Inadequate application of the nursing process. 3. Encounter with complex medical devices and complex conditions. 4. Inadequate application of physical examination by nurses.

Conclusion

There were both positive and negative experiences by undergraduate nursing students in teaching hospitals in Ghana. The opportunity to see various clinical cases and also use complex medical devices were positive experiences for students. However, the undergraduate nursing students also experienced challenges of isolation in placement, inadequate application of the nursing process, and inadequate application of physical assessment by nurses. Undergraduate nursing students require varying levels of support, supervisory commitments and logistics provisions to learn skills such as physical examination and nursing process during placement.

Electronic supplementary material

The online version of this article (10.1186/s12912-018-0325-8) contains supplementary material, which is available to authorized users.