Views and perceptions of nursing students on their clinical learning environment: teaching and learning

Nursing students' perceptions of inadequate nurse staffing in the clinical learning environment - a systematic narrative review

AIM

The aim of this study was to substantiate the perceptions and experiences of nursing students related to nurse understaffing in the clinical learning environment.

BACKGROUND

The quality of the clinical learning environment affects students' learning experiences, shapes their thinking about the profession and can influence their choice to stay or leave the profession. Understaffing in the clinical learning environment has an adverse impact on patient safety, quality of care outcomes and mortality. Understaffing has an impact on students' learning by reducing the quality of supervision and mentoring.

DESIGN

A systematic narrative review.

METHODS

Databases of Academic Search Premier, MEDLINE, Psychology and Behavioural Sciences, APA PsycINFO, APA PsycArticles, CINAHL, AMED were searched systematically. The review was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The reviewers independently conducted study selection, quality appraisal and data extraction. Quality appraisal was performed using the Mixed Methods Appraisal Tool (MMAT). Thematic analysis was used to synthesise the findings.

RESULTS

A total of eight research papers were included. Four themes were identified: inadequate support, feeling unprotected, being seen as a cover for staff shortages on shifts and patients ultimately suffer the consequences of understaffing.

CONCLUSIONS

This review revealed that understaffing in the learning environment meant that optimum level of supervision could not be provided, making students feel vulnerable and insecure, students felt unwelcome and used as cover for staff shortages. We recommend further examination of understaffing to inform policy for improvement in student-staff ratio, supervision and facilitation of learning.

Shifting Student Attitudes of Gerontology Nursing: A Quasi-Experimental Evaluation of a Clinical Educator Programme

BACKGROUND

Enduring shortages in the gerontology nursing workforce are projected to increase as demand for services for older persons grows. Recruitment of Registered Nurses in gerontology is further hindered by negative perceptions held by students towards nursing older people.

AIM

To determine whether a professional development activity designed to assist clinical supervisors to build the mentorship capacity of care staff in residential aged care facilities could positively improve their clinical learning environment and improve student attitudes towards working with older adults.

DESIGN

A quasi-experimental, non-equivalent pretest-posttest control group design.

SETTINGS

Clinical settings in which participants were undertaking an older person-focused clinical placement.

PARTICIPANTS

A purposive sample of 466 first-year undergraduate nursing students. Forty-seven students responded to both the pre- and post-placement surveys.

METHODS

The intervention comprised four professional development sessions delivered to clinical supervisors supervising nursing students during clinical placement across three residential aged care facilities. Pre- and post-placement surveys measured Student Perceptions of Working with Older People (SPWOP). The modified Clinical Learning Environment Inventory (CLEI) was included in the post-placement survey to measure student perceptions of the clinical placement learning environment.

RESULTS

Control group participants reported higher pre-placement SPWOP scores yet showed no significant improvement in score post-placement; however, the intervention group reported a statistically significant increase in SPWOP score post-placement. Modified CLEI results revealed the control group reported higher levels of engagement in the learning environment, yet the intervention group reported greater motivation to learn.

CONCLUSIONS

An intervention designed to build staff mentorship capacity in gerontology care settings can positively influence student perceptions of working in gerontology. Despite these positive gains, results indicated that students who undertook placement at the intervention sites were less engaged. This disparity illuminates the need for continued efforts to build staff mentorship capacity in older person-focused clinical learning environments to improve student experiences and perceptions of gerontology nursing.

IMPLICATIONS FOR PRACTICE

Further research that engages directly with unregulated healthcare workers in geronotological care settings could provide new insights into what this cohort need to become effective mentors and shift student nurse attitudes towards caring for older adults.

The mediating role of pediatric nursing competence in the relationship between pediatric drug administration self-efficacy and medical error tendency in nursing students

AIM

This study was conducted to determine the mediating role of pediatric nursing competence in the relationship between self-efficacy in pediatric drug administration and medical error tendency in nursing students.

BACKGROUND

The self-efficacy of nursing students towards drug administration knowledge and practices is one of the determinants of achieving the goals of nursing education programs related to drug administration.

DESIGN

The sample of the descriptive and correlational study consisted of a total of 303 3rd and 4th-year students taking the Pediatric Health and Diseases Nursing course at the Department of Nursing. Data were collected using the Pediatric Nursing Competency Scale (PNCS), the Medication Administration Self-Efficacy Scale in Children for Nursing Students (MASSC) and the Medical Errors Tendency Scale (METS). Pearson correlation analysis, linear regression analysis, independent groups t-test, one-way analysis of variance (ANOVA) and post hoc (Tukey, LSD) test were used to analyze the data. In addition, hierarchical regression analyses regarding the mediation effect were performed using PROCESS Model 4 developed by Hayes (2013) for SPSS.

RESULTS

When the correlation levels between the total scores of MASSC, PNSC and METS were analyzed, a positive moderate correlation was found between PNSC and MASSC total scores, a positive weak correlation was found between METS and MASSC total scores and a positive weak correlation was found between METS and PNSC total scores (p<0.05). As a result of the analysis, the model was found to be significant and the total change in METS was explained by 17.3 % of the total change in METS (F=63.289;p=0.000). It was found that PNSC was a partial mediator variable between MASSC and METS.

CONCLUSION

As a result of the study, it was determined that pediatric nursing competence had a partial mediating role in the relationship between pediatric drug administration self-efficacy and medical error tendency in nursing students.

Investigation of nursing students' emotional states toward challenging situations in clinical practice and metaphorical perceptions of the concept of a nurse

AIM

This study aims to determine nursing students' emotions toward the challenging situations they encounter in clinical practice and their metaphorical perceptions of the concept of a nurse.

BACKGROUND

Challenging situations in clinical practice negatively affect nursing students' perceptions of the nursing profession and their professional learning and development.

DESIGN

The study is based on quantitative, metaphorical and picture-drawing analysis.

METHODS

The quantitative and qualitative parts of it were conducted with 200 nursing students attending their first and second years in the 2021-2022 academic year. The Draw a Picture of a Cactus Test was carried out with 30 students in clinical practice. The data were collected using the "Sociodemographic Information Form" and the "Semi-structured Interview Form". Content analysis techniques, descriptive statistics, picture analysis and psychological tests were used to evaluate the data. The study was reported based on Standards for Reporting Qualitative Research (SRQR).

RESULTS

Nursing students involved in the study produced 37 metaphors related to the "concept of a nurse" and three most expressed ones were "mother, lifeguard and helper." The metaphors produced by nursing students were categorized under six roles: "caregiver, educator, supporter, researcher, administrator and therapeutic/rehabilitator". The pictures drawn by the students about the challenging situations in clinical practice and the expressions they used were associated with self-centeredness (n=21), being attentive (n=19), aggression toward peers (n=13), low motivation (n=11) and need for protection (n=11). Nursing students experienced feelings of loneliness, passivity and anxiety when navigating difficult conditions in clinical practice.

CONCLUSIONS

Metaphors and picture drawing allow a unique approach to the concept of nursing and nursing students' emotional states toward challenging situations in their clinical practice.

Exploring Undergraduate Nursing Students' Perceptions on Clinical Learning Environment in the UAE: A Focus on Perceived Benefits and Challenges

Introduction

Establishing a supportive clinical environment is paramount for enhancing nursing students' engagement in clinical practice, their clinical proficiencies, and satisfaction. The increase in nursing student enrollment at the Nursing College, driven by the collaborative efforts between Abu Dhabi Health Services Company (SEHA) and universities, has given rise to concerns regarding the quality of education and clinical instruction. These concerns are primarily due to the increased student-to-instructor ratio. Furthermore, the unsupportive clinical settings and learning tensions underscore the need to understand students' learning experiences and address research gaps within the field of clinical learning in the United Arab Emirates (UAE).

Objectives

The purpose of this study is to investigate the undergraduate nursing students' perceptions of their clinical learning environment, with a focus on perceived benefits and challenges.

Methods

This study used a cross-sectional survey design. The researchers administered a five-point Likert scale questionnaire, which had been adapted and contextualized, to a convenience sample of 217 third and fourth-year nursing students who willingly participated in this study.

Results

Despite the presence of positive aspects, such as diverse clinical experiences and strong support from both clinical instructors and peers, several challenges affect the students' clinical learning. These challenges encompass disparate perceptions of supervision among staff nurses, learning tensions related to student academic workload, insufficient clinical supervision, and difficulties in finding assistance when needed.

Conclusion

There is a clear need to enhance the overall ward learning environment to optimize students' academic motivation and clinical skills. Several measures can be taken to achieve this goal, including incentivizing and reducing the workload of staff nurses, investing in the professional development of clinical instructors, promoting peer interactions and group learning, and adopting a block pattern of education in years three and four for better clinical knowledge assimilation and reduced theoretical workload.

Modelling the case-based learning preferences of undergraduate nursing students using a discrete choice experiment in China

PURPOSE

To investigate the preferences for case-based learning programmes among undergraduate nursing students.

METHOD

A questionnaire was designed based on a discrete choice experiment, and 227 undergraduate nursing students were investigated. In STATA 15.0 software, the data were statistically analysed using a mixed logit model.

RESULT

All attributes in our study were found to have a significant influence on undergraduate nursing students' preferences for case-based learning programmes. The students' preference for the CBL programme was influenced by the clinical internship experience and type of university. Furthermore, the most ideal scenario was found to be video case modality, unfolding delivery, provided by academic experts and clinical instructors, group size 9-11, adequate feedback, and fragmented case content.

CONCLUSION

The undergraduate nursing students' preferences for case-based learning programmes were affected by the provider, case modality, modality, group size, feedback, and case content. Our results can provide useful information for nursing educators to gain insight into student preferences and formulate case-based learning programs.

Clinical experience of omani undergraduate nursing students: Qualitative study

Background

Commencing clinical practice is a main milestone in the educational journey of undergraduate nursing students as it indicates the beginning of their professional life. The clinical training experience is frequently described as stressful and challenging for nursing students.

Objective

s: This study was conducted mainly to examine, explore and interpret nursing students' perceptions of the challenges they faced as nursing students during their clinical experience.

Setting

College of Nursing at Sultan Qaboos University, Oman.

Participants

A total of 32 undergraduates nursing students who were enrolled in the nursing program and had finished at least one clinical course from their study plan.

Method

Data were collected using focus group discussions. A total of 32 participants were recruited and six focus groups were conducted. Data was transcribed and it was analyzed using thematic analysis.

Result

Two main themes were identified, and under each theme, several subthemes were merged. The two main themes are: challenges that hindered self-directed learning, which included instructor approach and nurse approach, and challenges that hindered experiential learning, which included theory-practice gap, insufficient practice, lack of confidence and evaluation methods.

Conclusi

on: This study provided insights into the challenges that hindered the effectiveness of clinical nursing education. Several recommendations were proposed to maximize the benefits of clinical practice and to create less stressful environments.

Barriers and enablers to scholarship for post basic nursing students in clinical service

BACKGROUND

Clinical scholarship is defined as an approach that enables evidence-based nursing and the development of best practices to meet the needs of clients efficiently and effectively. However, there are many barriers that impede its progress.

OBJECTIVE

This study aimed to identify the barriers and enablers to scholarship for post basic nursing students in clinical service areas.

METHOD

This multimethods study used a structured questionnaire followed by semi-structured individual interviews of post basic nursing students and their lecturers (nurse educators).

RESULTS

The 81 students who completed the questionnaire indicated a lack of support or funding assistance and mentoring, as well as no mechanisms to reward or recognise scholarship as top barriers to clinical scholarship. Top enablers were noticed as reward mechanisms in place, more protected time and availability of role models and mentoring. Twelve respondents engaged in the qualitative phase and three categories emerged from the data, namely (1) resource dependent, (2) 'what's the use of research', (3) making a change.

CONCLUSION

It has been shown that there is a need to adopt and promote a culture of clinical scholarship to ensure that the best available evidence is being utilised by nurses to effectively manage their patients; however, to support clinical scholarship, resources are needed.Contribution: This study highlighted the lack of funding and resources as being a major barrier to scholarship, together with an institutional culture that did not promote clinical scholarship. Providing protected time, mentoring and criteria for promotion and reward based on scholarship is viewed as enabling.

Nursing students' experiences and expectations of clinical learning: A qualitative study

BACKGROUND

Clinical learning is an important component of nursing education that can support the development of competence. Nursing students have expectations before clinical learning, however if these expectations are not matched with their experiences, then development can be hampered.

OBJECTIVE

To explore nursing students' expectations and experiences of their clinical learning experiences.

DESIGN

Qualitative descriptive design.

SETTINGS

The study was conducted at a large teaching hospital in Namibia.

PARTICIPANTS

Fifteen first to fourth year undergraduate nursing students who were allocated to a teaching hospital in Namibia.

METHODS

The participants were purposively sampled among the teaching hospital's undergraduate nursing students. Data were collected between June to November 2021 through in-depth, semi-structured interviews that lasted between 35 and 45 min each. Data were analyzed using thematic analysis.

RESULTS

The data analysis identified four themes: clinical outlook and role, supporting/role modelling, clinical teaching and learning, and linking theory and practice.

CONCLUSION

The expectations and experiences of nursing students regarding the clinical environment were mixed. The findings demonstrated the need to moderate students' expectations, as well as to reorganize the clinical learning environment to enhance students' learning. Further studies should look at the standardization of student expectations based on the context of their clinical learning environment, and how this can improve learning experiences.

Comparing Preferred and Actual Clinical Learning Environments and Perceptions of First-Year Nursing Students in Long-Term Care: A Cross-Sectional Study

The clinical learning environment, which includes the culture of clinical units, the mentoring process, and the different health organizations, influences the learning process of nursing students. However, scarce literature has been published on the impact of the clinical learning environment on first-year nursing students in long-term care. We aimed to assess first-year nursing students 'preferred' and 'actual' clinical learning environments when conducting their first placements in nursing homes within an innovative placement model that comprised the active participation of academic mentors. The validated Spanish version of the Clinical Learning Environment Inventory (CLEI) instrument was used in our study, and 99 first-year nursing students participated. The highest mean scores for the CLEI-Actual were found for the Satisfaction (22.7) and Involvement scales (19.09). The lowest mean scores were found for the Personalization (17) and Individualization (17.27) scales. The multiple correlation (R) between the Satisfaction and the other CLEI scales was 0.61 (p > 0.001), which means that in this study the association between student satisfaction and their perception of the clinical learning environment was strong. First-year students conducting their first clinical placements in nursing homes can have a positive learning experience considering a well-designed and organized pedagogical strategy, including constant support and feedback from academic and clinical mentors.

Development and psychometric testing of the non-technical skills scale in medical and surgical hospital units for nursing students

OBJECTIVE

To develop and validate a tool to assess the non-technical skills of medical and surgical hospital units undergraduate nursing students.

BACKGROUND

In the area of healthcare, non-technical skills complement technical ones, and contribute to patient safety. High-fidelity simulation is an ideal resource for working on these skills. Thus, evaluation instruments are needed to understand the efficiency of this methodology. Although many evaluation instruments already exist, none measure non-technical skills of undergraduate nursing students in medical and surgical hospital units.

DESIGN

An instrumental study design was employed.

METHODS

Two-phases were used to develop and validate the scale: 1) Scale development. A group of experts defined the dimensions and components. Afterwards, the content was validated by experts, and a pilot study was conducted with undergraduate Nursing students. 2) Analysis of the psychometric properties of the scale. A total of 393 students were evaluated in high-fidelity simulation scenarios by three evaluators, through the use of the Non-Technical Skills in Medical and Surgical Hospital Units (NTS-Nursing) Scale.

RESULTS

The content validity indexes were adequate for the total of the items and the total of the scale. The statistical descriptors of the items, the internal structure, and the reliability (internal consistency and inter-evaluator reliability) were analyzed, as well as the external evidence of validity, with adequate values obtained.

CONCLUSION

The NTS-Nursing scale is a valid and reliable instrument. Its structure of 10 items makes its use fast and easy.

Nursing students' experiences and perceptions of barriers to the implementation of person-centred care in clinical settings: A qualitative study

AIM

This study aimed to explore the barriers to implementing person-centred care based on nursing students' experiences during clinical practice.

DESIGN

This is a descriptive, qualitative study.

METHODS

Seventeen nursing students were recruited through purposeful sampling from two universities in South Korea. The semi-structured interviews consisting of open-ended questions were conducted. The collected data were analysed using an inductive content analysis method.

RESULTS

Five main categories were identified from nursing students' experiences: busyness, educational challenges, lack of awareness, lack of relationship building and lack of a policy approach.

Assessing Professional Competencies Among Undergraduate Nurses: An Exploratory Study

AIM

The study aimed to identify nursing students' professional competencies and examine which factors of the clinical learning environment affect these competencies.

BACKGROUND

Professional competencies are vital for the quality and safety of nursing practice. The learning environment is important for the development of professional competencies.

METHOD

Data were collected from 178 nursing students using the Clinical Learning Environment and Supervision Scale and the Nursing Professional Competencies Scale-Short Form.

RESULTS

The highest competency was achieved in value-based nursing care; the lowest competency was achieved in development, leadership, and organization of nursing. Factors such as positive pedagogical atmosphere, nursing care on the ward, and good supervisory relationship affected learning and, in turn, improved professional competencies.

CONCLUSION

The results establish a link between the clinical environment and reported professional competencies, leading to a call for more focused coverage of these factors in the academic curricula.

Exploring the formal assessment discussions in clinical nursing education: An observational study

Introduction

According to EU standards, 50% of the bachelor education program in nursing should take place in clinical learning environments. Consequently, this calls for high quality supervision, where appropriate assessment strategies are vital to optimize students’ learning, growth, and professional development. Despite this, little is known about the formal assessment discussions taking place in clinical nursing education.

Objective

The aim of this study was to explore the characteristics of the formal assessment discussions taking place during first-year students’ clinical education in nursing homes.

Method

An exploratory qualitative study was performed. The data consist of passive participant observations of 24 assessment discussions (12 mid-term and 12 final assessments) with first-year nursing students (n=12), their assigned registered nurse mentors (n=12) and nurse educators (n=5). The study was conducted in three public nursing homes in a single Norwegian municipality. Data were subjected to thematic analysis. The findings were reported using the Standards for Reporting of Qualitative Research.

Results

Three themes were identified regarding the characteristics of the formal assessment discussions: (1) adverse variability in structuring, weighting of theoretical content and pedagogical approach; (2) limited three-part dialogue constrains feedback and reflection; and (3) restricted grounds for assessment leave the nurse educators with a dominant role.

Conclusion

These characteristic signal key areas of attention to improve formal assessment discussions to capitalize on unexploited learning opportunities.

Changes in professional commitment of undergraduate nurse students before and after internship: a longitudinal study

BACKGROUND

Experiencing internship shapes nursing students' professional commitment and aggravates its changes. However, few studies have been investigated how this changes empirically.

OBJECTIVES

The aims of this study are to investigate (a) what are the changes of professional commitment of nursing students before and after the internship? (b) Which of multiple independent variables is the strongest predictor?

METHODS

A longitudinal study was conducted with 996 senior undergraduate nursing students (ready to enter clinical practice) in the China universities. The survey was conducted in the spring of 2015 and autumn of 2016. The data were collected by a paper-and-pencil questionnaire. The instruments used included Professional Commitment Scale and Perceived Stress Scale. Analysis of paired t-test and linear regression analysis were performed on the data.

RESULTS

Nursing students showed lower professional commitment (2.79 ± 0.36) than they were (2.92 ± 0.36) before internship. Socio-demographic variables, pre-internship professional commitment and stress perceived during internship predicted 40.1% of the variance in the post-internship commitment.

DISCUSSION

These data summarize the nursing students' professional commitment changes and the main influential factors that contribute to post-internship professional commitment of undergraduate nursing student. The findings are timely, which indicate that senior nursing students' professional commitment can be increased by enhancing pre-internship commitment and reducing students' stress levels during internship.

Effectiveness of a Problem-Based Geropsychiatric Nursing Clinical Internship Program

Clinical internships that effectively incorporate the care of older adults with mental health disorders are sparse in many countries, including Taiwan. This study investigated the effectiveness of a problem-based geropsychiatric clinical internship program for nursing students in Taiwan. We conducted a quasi-experimental study among 126 nursing students. Experimental and control groups received problem-based geropsychiatric and general psychiatric practice sessions, respectively. Knowledge, attitude, skills, and self-reflection were evaluated before (T1) and after (T2) measurements. There were no significant differences between the groups in knowledge, attitude, skills, and self-reflection at T1. At T2, knowledge was significantly higher in the experimental group (t = 2.39, p = 0.02). Attitude, skills, and self-reflection ability did not differ between the groups at T2. Our results showed that clinical problem-based approaches can be applied in geropsychiatric mental health nursing internship programs. The problem-based approach was helpful in improving nursing students' knowledge about psychiatric symptoms and the health problems of older adults with mental illness. However, it did not significantly enhance or change the attitudes, skills, or the ability to self-reflect among students.

Integrating simulation training during clinical practice in nursing homes: an experimental study of nursing students' knowledge acquisition, self-efficacy and learning needs

BACKGROUND

Limited access to supervision, feedback and quality learning experiences pose challenges to learning in the clinical setting for first-year nursing students who are beginning their clinical experiences. Prior studies have indicated that simulation training, as a partial replacement of clinical practice hours, may improve learning. However, there has been little research on simulation training integrated as a partial replacement during first-year students' clinical practice in nursing homes. The primary aim of this study was to examine first-year nursing students' knowledge acquisition and self-efficacy in integrating a partial replacement of clinical hours in nursing homes with simulation training. Its secondary aim was to examine perceptions of how learning needs were met in the simulated environment compared with the clinical environment.

DESIGN

The primary aim was addressed using an experimental design that included pre- and post-tests. The secondary aim was investigated using a descriptive survey-based comparison.

METHODS

First-year students at a Norwegian university college (n = 116) were asked to participate. Those who agreed (n = 103) were randomly assigned to the intervention group (n = 52) or the control group (n = 51). A knowledge test, the General Self-efficacy Scale and the Clinical Learning Environment Comparison Survey were used to measure students' outcomes and perceptions. The data were analysed using independent samples t-tests, chi-square tests and paired samples t-tests.

RESULTS

Knowledge scores from pre- to post-tests were significantly higher in the intervention group than in the control group with a medium to large effect size (p < 0.01, Hedges' g = 0.6). No significant differences in self-efficacy were identified. Significant differences (p <  0.05) were observed between the simulated and the clinical environment with regard to meeting learning needs; effect sizes ranged from small and medium to large (Cohen's d from 0.3 to 1.0).

CONCLUSION

Integrating the partial replacement of clinical hours in nursing homes with simulation training for first-year nursing students was positively associated with knowledge acquisition and meeting learning needs. These findings are promising with regard to simulation as a viable partial replacement for traditional clinical practice in nursing homes to improve learning.

Insights on my future job: implementing near-peer shadowing program for operating room freshmen

BACKGROUND

As a main challenge in paramedical faculties of medical sciences, freshmen lose interest in their academic field of study and then job motivation. Lack of developed knowledge about their academic field and unfamiliarity with their future job's tasks and roles contribute to freshmen's job motivation loss. Various interventional programs have been implemented to improve students' job motivation by familiarizing them with their future job's duties and responsibilities.

METHODS

This was one-group pretest-posttest design study in 2019-2020. Students grouped into pairs of a freshman (shadowee) with a senior (shadower) in a clinical setting during shadowing program. This program helps freshmen to comprehend and discover realities of their academic field and can help them change their perspectives regarding their future job's duties and responsibilities. The shadowees' main task was reflective observation on operating room events and interactions and to be active in the program, several tasks e.g., how to wear gloves, guns, and disinfect equipment were assigned to them exclusively under the supervision of senior students. The Hackman and Oldham's Job Diagnostic Survey (JDS) questionnaire and a novel Job Motivation Survey (JMS) questionnaire were distributed among participants.

RESULTS

Fifty freshmen majoring in operating room participated in the shadowing program from November 2019 to January 2020. Before and after the program, they completed Hackman and Oldham's job diagnostic survey and researcher-made job motivation survey questionnaires. Results were indicative of a significant difference in job diagnostic survey questionnaire score, where overall pre-test and post-test scores before and after the intervention were 57.78 (±9.78) and 68.58 (±5.02), respectively; the score difference was statistically significant (P < 0.001). Moreover, the overall pre-test and post-test scores of the job motivation survey questionnaire were 25.16 (± 9.75) and 39.80 (±5.18), respectively; this score difference was statistically significant (P < 0.001).

CONCLUSION

Shadowing program improved freshmen's realistic perception of their future job's duties and responsibility, and hence enhancing their job motivation and job recognition. As future work, in various disciplines, further studies need to evaluate the impact of such interventional programs in providing early insights for freshmen as well as in providing guidance on their plans for education, and future job.

Professional identity, wellness, and future hope among nurse interns in Egypt

Objective

Since nursing is a performance-based profession, clinical learning environments play an important role in the acquisition of professional abilities and train nursing students to enter the nursing profession and become a registered nurse. The study aimed to investigate the relations among professional identity, wellness, and future hope in nurse interns.

Methods

A cross-sectional, analytic, descriptive, correlational study design was used to test these relations in the study where 210 nurse interns’ students were selected using a convenience sampling from Zagazig University hospitals and Suez Canal University hospitals in Egypt. The questionnaires consisted of 4 parts, namely demographic characteristics, Professional Identity Scale for Nursing Students (PISNS), Holistic Health and Wellness Survey, and Hope scale.

Results

Less than half of the study sample had chosen nursing specialty by own will (43.8%), while slightly more than half of them had a “very good” graduation level, and had no nursing role model. The lowest mean professional identity score was for independence in career choice while the highest was for social modeling. The reported physical wellness mean-score was the least, while social wellness was the highest. Professional identity, wellness, and future hope scores differed significantly based on nurse interns’ personal characteristics. There were statistically significant, positive, weak-to-moderate correlations among the scores of professional identity, wellness, and future hope; however, the “choice of nursing study by own will” was a statistically significant independent positive predictor of the scores of professional identity, wellness, and future hope.

Conclusions

Nurse interns’ professional identity, wellness, and future hope were positively inter-correlated. However, nurse interns’ wellness was the lowest, and it should be fostered as it was the main predictor for future hope. The internship programs should be modulated to improve nurse interns’ professional identity, particularly regarding independence, and should foster their well-being in the clinical environment.

Usability and value of a digital learning resource in nursing education across European countries: a cross-sectional exploration

Background

Higher education is responsible for providing education that meets international benchmarks relevant to the needs of the international community. Due to the increase of digital tools in higher education, the possibility of sharing learning resources across nations has expanded. In the current project, a Norwegian university invited universities in Spain and the United Kingdom to adapt and translate e-learning resources originally developed for Norwegian nursing students for use within their respective Bachelor in Nursing programmes.

Aim

The aim of the current study was to gain insights into the usability and value for learning of e-compendiums shared and implemented across three European universities.

Methods

The study adopted a descriptive cross-sectional design and included nursing students from the University of Nottingham, Valencia Catholic University, and the University of Stavanger. Data were collected in Autumn 2017 through a questionnaire adapted from the validated “Centre for Excellence in Teaching and Learning Reusable Learning Object evaluation questionnaire” The questionnaire consisted of 19 items that included two aspects: e-compendiums’ value for learning and e-compendiums’ usability. The different study sites were compared using a binary logistic regression analysis. Subgroups of students were compared based on their gender and age.

Results

A total of 480 nursing students participated in the study. The e -compendiums were overall positively rated, especially for reinforcing and retaining knowledge. Compared to the students from the University of Stavanger, students from Valencia Catholic University rated the e-compendiums more positively in most aspects of learning. Students from University of Nottingham found the e-compendiums to be more important for learning engagement compared to students at the Norwegian study site, and no differences were found in any other aspects of learning. Younger students rated the interactivity and visual components as more important compared to older students.

Conclusions

Students from the University of Nottingham and Valencia Catholic University seem to accept the e-compendiums despite the fact that they were originally developed for use in another country. We argue that, when sharing e-learning resources across countries, an adaptation and translation process that includes a multicultural and multidisciplinary perspective should be carried out.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12912-021-00681-5.

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.

Satisfaction with the clinical practice among nursing students using regression models and qualitative comparative analysis

BACKGROUND

Clinical practice is considered fundamental in nursing studies for the effective education of nurses and students' satisfaction. Both the clinical environment and the clinical educator are key factors in students´ satisfaction.

OBJECTIVES

To analyze the influence of the socio-demographic variables of clinical educators and nursing students on satisfaction with the clinical practice.

DESIGN

This was an observational, cross-sectional study.

SETTINGS

A clinical practice course at a private university in Valencia, Spain.

PARTICIPANTS

The study included 527 nursing students enrolled on the clinical practice, supervised by 187 clinical educators.

METHODS

Two statistical methodologies were used for data analysis: hierarchical regression models (HRM) and fuzzy-set qualitative comparative analysis model (fsQCA).

RESULTS

The results indicate that sociodemographic variables such as sex, being a woman, and being in the second grade year group, influence student satisfaction in both methodologies.

CONCLUSIONS

According to our results, establishing specific academic plans for students in higher years (3rd and 4th) could improve nursing students' satisfaction with their clinical practice. Adequate training of students is a key factor in the provision of high-quality nursing care.

Differences in critical thinking skills between nursing students on a fast-track versus traditional 4-year programme

BACKGROUND

The authors were unable to find studies comparing the critical thinking skills of nursing students on advanced standing programmes (ASP) and on traditional 4-year BN programmes in Canada. The ASP is a condensed Bachelor of Nursing (BN) programme, designed for students who already have a university degree or similar qualification.

AIM

To measure and compare the critical thinking skills of ASP students and traditional 4-year BN students.

METHOD

A cross-sectional study using a self-administered questionnaire used to collect data from 100 nursing students at a university in Canada. Data were analysed using descriptive and inferential statistics. All research ethics were taken into consideration.

FINDINGS

All participants scored highly in their critical thinking skills. However, ASP students scored significantly higher than their counterparts on the 4-year programme (M=21.6 vs M=18.9, F=4.75, P=0.035).

CONCLUSION

Higher critical thinking skills among ASP nursing students is a promising sign to expand and support this type of programme as a fast and effective method to cover the shortage in nurses.

A "Co-CREATES" framework to foster a positive learning environment for nursing students' professional development in Rwanda

AIM

The future of the nursing profession in Rwanda in large part depends on the students who join the workforce and the education they have received. Preparing students with the necessary knowledge, values and judgement requires practice settings to be learner-centered. This study aimed at exploring strategies that might improve the current practice-based learning environment.

DESIGN

A focused ethnographic approach was used.

METHODS

Nursing students, staff nurses, clinical instructors and nurse leaders from three hospitals and an educational program participated in individual interviews.

RESULTS

Five key areas of improvement emanated from study data: 1) strengthening institutional support; 2) improving school-hospital collaboration; 3) building the capacity of nurses and clinical instructors; 4) restructuring clinical placement; and 5) reviewing the current supervision model. Based on these findings a "Co-CREATES" framework grounded in the actions of collaboration, care, recognizing, empowering, actively engaging, transforming, enhancement and support was developed. The framework offers a collaborative approach that engages every stakeholder in "cocreating" conditions that build positive practice environments which are conducive to preparing students as professional nurses.

CONCLUSION

The positive outcomes stemming from such a collaborative approach can further enhance a positive culture of collaboration in nursing education and practice.

Undergraduate nursing student academic resilience during medical surgical clinical practicum: A constructivist analysis of Taiwanese experience

BACKGROUND

Nursing students often experience a reality shock in the course of their practicums that can significantly impact their studies.

PURPOSE

This study aimed to explore the academic resilience of undergraduate nursing students during their Adulting Nursing practicums and identify protective factors to mitigate their impact.

METHODS

The constructivist grounded theory approach enabled us to explore nursing students' academic resilience in their practicums. Purposive and theoretical sampling was used to recruit 19 participants. Individual in-depth interviews were audio-recorded and transcribed verbatim. The constant comparative method directed theoretical sampling. The criteria of credibility, originality, resonance, and usefulness were considered to ensure the quality and trustworthiness of the study.

RESULTS

The main challenges were related to facilitators, the environment, and application of techniques. Students reported feelings of 'walking on thin ice' and doubts about their decision to pursue a nursing career. Academic resilience was identified as the ability to maintain optimism while facing challenges. Participants concluded that overcoming their ignorance through practical learning was an important outcome of the process of developing academic resilience.

CONCLUSION

The findings highlight the need for facilitators to re-examine their teaching strategies and provide supplementary support to help students to improve their academic resilience.

What Academic Factors Influence Satisfaction With Clinical Practice in Nursing Students? Regressions vs. fsQCA

Clinical practices are considered one of the cornerstones in nurses' education. This study provides a framework to determine how factors in the academic environment, influence nursing student's satisfaction with their practices. A cross-sectional analytical study was conducted in a convenience sample of 574 nursing students at a private university in Valencia, during the 2016/2017 academic year, 79% (456) were women. Two statistical methodologies were used for data analysis: hierarchical regression models (HRM) and fuzzy sets qualitative comparative analysis (fsQCA). The HRM indicate that the students' mean score influences all dimensions of satisfaction. Furthermore, in the fsQCA, the type of service and center, as well as the type of management, the preference in the choice of the practice center and the number of students per period per clinical educator influence satisfaction with clinical practices. These results could be used to understand how academic factors influence nursing students' satisfaction with their clinical practices and to create intervention programmes that improve it. This will help prepare students to be the future nursing workforce.

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.

Magnet hospital attributes in nursing work environment and its relationship to nursing students' clinical learning environment and satisfaction

AIMS

To analyse nursing students' perception of the Magnet hospital attributes of the work environment at the hospitals where they perform their clinical placement and the relationship of this factor to their clinical learning environment and supervision, satisfaction and intention to stay in those hospitals once graduated.

DESIGN

This study had a cross-sectional, correlational, design.

METHODS

Data were collected using self-reported questionnaires from 180 nursing students at a university in southeast Spain between September-October 2018. Nursing work environment and clinical learning environment were measured using the Practice Environment Scale of the Nursing Work Index and Clinical Learning Environment, Supervision and Nurse Teacher scale, respectively. Students' satisfaction with the work environment and with the clinical learning process were measured using a four-point Likert scale developed by the researchers. Percentages, frequencies, mean, standard deviation, χ² test, Mann-Whitney U test, Spearman and phi correlation were used to analyse the data.

RESULTS

Nursing students' perception of greater Magnet-like features at work environment was associated with better clinical learning environment (Spearman rs = |0.22-0.54|; p < .01) and satisfaction with the work environment (Spearman rs = 0.18; p = .01) and with their learning process (Spearman rs = 0.21; p < .01). Greater intention to stay working in the hospital after graduation was significantly associated with greater satisfaction with the learning process (phi = 0.31; p < .01) and the work environment (phi = 0.23; p = .02).

CONCLUSION

Magnet-like features at the work environment lead to superior clinical learning environment and higher students' satisfaction, two factors that play a decisive role in their decision to stay at hospitals where they performed clinicals after graduation.

IMPACT

In the face of a global nurse shortage, nursing managers and faculty leaders should consider the improvement of nursing workplaces as a strategic alliance to promote satisfactory clinical learning experience and aid recruitment of nurses.

The relationship between the undergraduate clinical learning environment and work readiness in new graduate nurses: A pre-post survey study

BACKGROUND

Due to projected nurse shortages, it is necessary that undergraduate programs optimise work readiness outcomes in new graduate nurses. Research that quantitatively evaluates characteristics of clinical nursing programs that predict increased work readiness is required.

OBJECTIVES

To explore the relationship between the undergraduate clinical learning environment and nurse perceptions of work readiness prior to and following, commencement as a new graduate nurse.

DESIGN

A pre-post follow-up study. Undergraduates were surveyed at the end of their Bachelor's degree (baseline) and at 8-10 weeks after commencement as a graduate nurse (Time 1).

SETTING

A multi-site, metropolitan private hospital in Victoria, Australia.

PARTICIPANTS

Nursing graduates who completed a university fellowship program (n = 26), or were undertaking their graduate year and had completed placement blocks within (n = 18) or outside (n = 31) the healthcare organisation.

METHODS

Participants self-completed the Clinical Learning Environment Inventory (CLEI) and Work Readiness Scale for Graduate Nurses (WRS-GN) at baseline and Time 1. Multiple regression analyses were performed.

RESULTS

CLEI scores significantly predicted work readiness outcomes (all p-values<.05), accounting for 16-36% and 17-28% of the variance of WRS-GN scores at baseline and Time 1, respectively. After adjusting for clustering due to clinical placement groups, CLEI Individualisation (p = .023) and Valuing Nurses Work (p = .01) predicted improved Time 1 WRS-GN Organisational Acumen. CLEI Innovative and Adaptive Culture scores predicted poorer Time 1 Organisational Acumen (p = .001).

CONCLUSIONS

Learning environments that offered high levels of individualised attention and valued nurses' work appeared to facilitate post-graduation engagement and identification with nursing practice. However, highly innovative and adaptive education may detract from optimal work readiness. Findings revealed that while important, the clinical learning environment only accounted for a small-to-moderate degree of nursing graduates' work readiness. To facilitate robust evidence-based improvement of clinical nursing education, future research should attempt to empirically establish the value of additional facilitators of work readiness.

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.

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.

University educational management and clinical practice applied to nursing by the faculty of a public university

OBJECTIVE

to emphasize university educational management actions and their articulation to develop clinical practice in nursing training, designed by its faculty.

METHODS

a single-case study with qualitative approach. The sources were composed of documentary research, focused interview with key informant and direct non-participant observation. Data were organized with the help of NVivo®10. Analysis followed the explanation construction technique from the perspective of complex thinking.

RESULTS

three categories emerged: Characterization of university educational management actions; Articulation of university educational management with clinical practice and its repercussion; and Spaces to develop university educational management and clinical practice. Final considerations: university educational management actions are associated with the work of professors, supporting teaching, research, and extension in order to improve clinical knowledge in the general nursing training.

Education Program for Carers in Facilities with Neuro Disabled Subjects EPoCFiNDS

The prevalence of chronic illness and the disabilities they cause are strongly associated with age. According to the United Nations, in most countries around the world, 8-10% of the population has some form of disability. Carers are helping subjects who have severe or profound core activity limitations in the community and hospice facilities. The skills acquired by carers in their caring role are relevant to the competencies required for occupations and qualifications in community, aged care, health, youth, housing and disability support services. With the aging population the number of subjects with neurological lesions living in hospices and long-term care facilities is increased. It makes a strong case to educate carers to help these subjects. There is a lack of evidence on how to design and implement mechanisms such as foundation skills courses and programs to best meet the needs of carers. The goal of Education Program for Carers in Facilities with Neuro Disabled Subjects (EPoCFiNDS), is to create training programs for carers in neurodisabled subjects living in various facilities. In Europe we need to develop educational programs, aimed at volunteers, relatives or any other group of people so that they better organize benefits care for neurodisabled subjects.

Relationships between reality shock, professional self-concept, and nursing students' perceived trust from nursing educators: A cross-sectional study

BACKGROUND

Nursing students establish their professional role through clinical practice. However, during the first clinical practice, they might experience reality shock given the gap between theory and practice, which could negatively influence their professional self-concept. Furthermore, nursing educators in clinical practice play an important role in improving nursing students' clinical experience.

OBJECTIVES

To examine the relationship between nursing students' reality shock and professional self-concept, and to examine the associations of perceived trust from nursing educators with nursing students' reality shock and professional self-concept.

DESIGN

A cross-sectional, descriptive correlational study.

SETTING

Nursing schools in one metropolitan area and three cities in South Korea.

PARTICIPANTS

Data were collected from 184 nursing students who experienced their first clinical practice in preceding four weeks of data collection.

METHODS

Surveys assessing participants' characteristics, reality shock, professional self-concept, and perceived trust from nursing educators were conducted. A hierarchical regression analysis was performed to examine the relationship between reality shock and professional self-concept, and the relationships between perceived trust from nursing educators and nursing students' reality shock and professional self-concept.

RESULTS

Nursing students' reality shock was negatively related to their professional self-concept. Perceived interpersonal relationship with nursing educators was positively related to professional self-concept and negatively related to the experienced reality shock. Furthermore, this negative relationship decreased when reality shock was combined with perceived interpersonal relationship with nursing educators.

CONCLUSIONS

Nursing students' reality shock during their first clinical practice may be negatively associated with the establishment of their professional self-concept. However, students' reality shock could be reduced by enhancing their interpersonal relationship with the nursing educator, which might reduce the negative association of reality shock with professional self-concept. Therefore, nursing educators should develop skills to establish interpersonal relationships with students to positively influence students' clinical adaptation.

Nursing students' perception of patient-centred care: A qualitative study

Aim

This study aimed to explain the understanding of nursing students from the concept of patient-centred care.

Design

This is an explorative and descriptive-qualitative design.

Methods

The participants consisted of 15 nursing students who were selected through purposeful sampling, and data were collected through in-depth, semi-structured interviews and analysed using a qualitative content analysis.

Results

Data analysis led to the identification of three categories including the following: the inevitability of patient-centred care, the patient-centredness in comprehensive care and the importance of nursing process in patient-centred care. Introducing students to the concept of patient-centred care and how it can be achieved seems necessary during nursing education. Introducing a module on patient-centred care to the nursing curriculum is suggested to familiarize students with this concept.

Culturally and linguistically diverse healthcare students' experiences of the clinical learning environment and mentoring: A qualitative study

Development of educators' and students' global competence in higher education is increasingly important due to internationalization. Internationalization significantly influences healthcare education through an increase in the mobility of students. When conducting clinical practice in healthcare education, culturally and linguistically diverse healthcare students face the challenges of having limited learning opportunities and social isolation. Further investigation is required of students' experiences in this area while asking them to share their experiences. This study aimed to describe students' experiences of clinical learning environment and mentoring. A qualitative research design was used during 2013-2016. Data were collected from 133 culturally and linguistically diverse healthcare students, including exchange students and students studying in English language-taught degree programmes at eight Universities of Applied Sciences in Finland. Data were analysed using inductive content analysis. Students' experiences were related to their mentors' competence in mentoring, culturally diverse pedagogical atmosphere, and aspects of diversity that influence clinical learning. Students reported that they had experienced social isolation, discrimination, bullying, sexual harassment and prejudice during their clinical placements. These issues related to mistreatment of students need to be addressed. Also, structured clinical environments should be developed in which competent mentors assist students in reaching their clinical placement goals.

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.

How do nursing students experience the clinical learning environment and respond to their experiences? A qualitative study

INTRODUCTION

On entry into the clinical environment, nursing students are confronted with many challenges. It is a common problem throughout the world, including Iran. Although many studies have been conducted on the problems of nursing students in the clinical environment, limited information is available on nursing students' experiences of the clinical learning environment and the way they respond to these experiences. Identifying nursing students' experiences is essential to develop interventions to reduce challenges.

OBJECTIVE

This study aimed to explore nursing students' experiences in a clinical learning environment and the way they responded to these experiences.

DESIGN

The present study was conducted based on the qualitative research design of the grounded theory methodology.

SETTING

This study was conducted at schools of nursing in academic settings in Iran.

PARTICIPANTS

The participants included 19 nursing students, 4 nursing instructors and 3 clinical nurses.

METHODS

The data were collected using semistructured interviews, field notes and observation, and were analysed using Strauss and Corbin's approach.

RESULTS

Students, as a result of the inadequacy of the educational environment, were faced with 'confusion of identity', stating this as their main concern. When confronted with this concern, they employed specific strategies, some of which prevented them from getting into unpleasant conditions. These strategies did not help students solve their problems and also prevented them from accepting their professional roles and responsibilities. Conversely, some other strategies led them to advanced professional development and enabled them to accept their role and the clinical environment.

CONCLUSION

According to the results of this study, educational policymakers should focus on improving the clinical environment. Identifying professional models and increasing their influence on management, education and clinical education, as well as teaching positive and constructive strategies, will promote positive strategies in coping with inadequate educational contexts. This is necessary for the professional development of nursing students.

The effectiveness of shared clinical teaching in nursing

AIM

Clinical learning is a critical component of a nursing curriculum. Student satisfaction in clinical environment is crucial to foster a positive learning experience. Faculty shortages have made clinical teaching more challenging; as such, alternate models of clinical teaching must be explored by nursing programs. The purpose of this study was to measure the perception of student satisfaction in regard to the effectiveness of shared clinical teaching in nursing.

METHODS

Utilizing Chan's Clinical Learning Environment Inventory (CLEI), this quantitative comparative study examined nursing students' preferred and actual clinical learning environment. The CLEI contains 42 questions in six subscales: Individualization, Innovation, Involvement, Personalization, Task Orientation, and Satisfaction in both the actual and preferred clinical learning environment. The sample consisted of 202 nursing students in two groups: the first group had 91 students who experienced shared clinical teaching with two faculty, whereas the second group had 111 students who experienced the traditional, single faculty model. The results were analyzed using independent sample T-tests.

RESULTS

The preferred learning environment was rated highest in all six subscales. Scores of the Satisfaction subscale and the Innovation subscale for Actual Learning Environment, and the score of the Innovation subscale for Preferred Learning Environment of students experiencing shared clinical teaching with two faculty were higher than the scores of students experiencing traditional, single faculty model, with statistically significance (P＜0.05).

CONCLUSION

The results indicated students preferred the shared clinical teaching model with two faculty over the single faculty model. Nursing programs can utilize this model and apply these results to develop and maintain quality clinical teaching.

Student nurses' perceptions of their educational environment at a school of nursing in Western Cape province, South Africa: A cross-sectional study

Background

Educational environments have been found to bear a substantial relationship with the academic performance and success, as well as the retention, of students.

Objectives

The study objectives were to (1) evaluate the educational environment as perceived by undergraduate nursing students at a school of nursing (SON) in Western Cape province and (2) investigate whether the educational environment, or components thereof, is perceived negatively or positively among undergraduate nursing students of different year level, gender, home language and ethnicity.

Method

A quantitative research method with a cross-sectional design was implemented. Data were collected from 232 undergraduate nursing students from a SON at a university in Western Cape province, South Africa. The subscales and the items of the educational environment questionnaire were compared among undergraduate nursing students. Data were analysed by means of the IBM Statistical Package for Social Sciences (IBM SPSS-24) using analysis of variances (ANOVAs), independent-sample t-tests, mean scores, standard deviations and percentages.

Results

The mean score attained for the entire participant group was 195 (standard deviation [SD] = 24.2) out of 268 (equivalent to 72.8% of maximum score), which indicated that the educational environment was perceived substantially more positively than negatively. The overall mean score was significantly higher (p < 0.05) for male students (M = 202; SD = 21) and for black students (M = 202; SD = 21). The digital resources (DR) subscale was the only subscale with a statement or item that was rated as absolute negative (M = 1.9; SD = 0.9).

Conclusion

The educational environment at the institution concerned was perceived as predominantly positive by its undergraduate nursing students. Although the educational environment was predominantly perceived as positive, the results of this study also indicated that enhancements are required to improve the physical classroom conditions, skills laboratories, DR and the implemented teaching and learning strategies. It is vital for university management to prioritise the creation of an educational environment which would ensure that quality learning takes place.

Keywords

student’s perceptions; educational environment; nursing education; Western Cape; South Africa.

Development of a web-based tool to evaluate competences of nursing students through the assessment of their clinical skills

BACKGROUND

Assessing the clinical ability of nursing students continues to be a fundamental challenge within the nursing degree. Designing innovative teaching strategies while ensuring an educational experience that results in safe nursing practices is an additional challenge for all educators.

OBJECTIVES

To design, develop and implement a tool to evaluate the clinical skills of nursing students.

DESIGN

A two-phase study. In the second phase, a pre-experimental study was conducted.

SETTINGS

Health Sciences Department of the University of Almería, Spain.

PARTICIPANTS

250 Nursing students in the second year of their degree.

METHODS

The study was divided into 2 phases: 1st) Web-based tool design and development and 2nd) Usability testing. In the second phase, a pre-experimental study was conducted both with an experimental group and a control group.

RESULTS

In the first phase, a panel of 15 experts confirmed that the content and technical aspects of the tool were adequate (scores of 4-5/5). In the second phase, the participants of the experimental group showed higher final scores in the evaluated skills section, as well as shorter evaluation time and a greater number of observations and registered incidents than the participants in the control group. Finally, the students of the experimental group indicated a greater degree of satisfaction with the evaluation system used.

CONCLUSIONS

The web-based tool designed is an effective strategy to evaluate clinical skills. It is important to have strategies and instruments that allow us to demonstrate the development and acquisition of the skills required for future nursing professionals.

Experiences and perceptions of the theory-practice gap in nursing in a resource-constrained setting: A qualitative description study

AIM

To describe experiences and perceptions of theory-practice gap in nursing in a resource-constrained setting. Theory-practice gap is extensively discussed and studied in some parts of the world. Interventions to bridge the theory-practice gap have been varied and depend on an understanding of the contextual healthcare environment. Experiences and perceptions of the theory-practice gap in a resource-constrained setting have not been comprehensively described.

DESIGN

A qualitative description methodology was used.

METHODS

Maximum variation sampling based on role in the events of theory-practice gap was used to recruit student nurses, nurse faculty and clinicians from two study sites for focus group discussions. Data were analysed using conventional content analysis.

RESULTS

Five themes were identified: system inadequacies; resource constraints; challenges of the clinical learning environment; clinical placement and supervision; and nurse faculty factors. Systems inadequacy and resource constraints formed the spine of the challenges contributing to the theory-practice gap in the research setting.

Translation and validation of a Vietnamese version of the modified Clinical Learning Environment Inventory (V-CLEI)

The quality of students' experiences in an education environment directly affect learning outcomes. In an applied profession such as nursing, students undertake work-integrated learning in unpredictable health settings where multiple influences interact. Understanding students' perspectives with a valid instrument is the first step in improving learning environments and maximizing learning outcomes. It is important that language and cultural nuances are accounted for when instruments are translated. This paper reports translation and psychometric properties of the Vietnamese language version (V-CLEI) of the modified English language Clinical Learning Environment Inventory (CLEI) (Newton et al., 2010). The V-CLEI was tested with a convenience sample of 209 Vietnamese nursing students to assess clinical learning experiences in hospitals in central Vietnam. The internal consistency, test-retest reliability, content validity and factor structure of the V-CLEI were examined. Results indicate that the V-CLEI is unlikely to be valid and reliable in the Vietnamese context and revision is required. This study informs research, particularly the different cultural dimensions considered when translating and adapting instruments.