Evaluating the preceptor role for pre-registration nursing and midwifery student clinical education

Turkish validity and reliability study of midwifery student evaluation of practice (MidSTEP) tool

BACKGROUND

In midwifery education, clinical learning environments have a significant impact on students' acquisition of clinical competence and professional self-identity. The Turkish version of the MidSTEP can be used a measurement tool to assess midwifery students' perceptions of their clinical learning environment experiences and the positive effects of preceptor on the professional development of midwifery students.

AIM

This research was conducted to determine the Turkish validity-reliability of MidSTEP.

METHOD

This research, which was designed as a methodological study, was conducted with volunteer students studying in the first, second, and third years of midwifery at a university in Turkey. The MidSTEP consists of the Clinical Learning Environment Scale and Impact of the Midwifery Preceptor Scale, each with two subscales. The validity and reliability of the MidSTEP were assessed using Exploratory Factor Analysis, Cronbach's alpha, and Intraclass Correlation Coefficient.

PARTICIPANTS

In this study, 205 students were included in the research sample, considering that it may not be sufficient to reveal the factor structure when the number of scale items and the sample size is less than 200.

RESULTS

As a result of the factor analysis a 26 item measurement tool of two scales and each with two sub-dimensions was achieved. The Turkish version of the MidSTEP Tool matched the original scale in terms of the number of items and factor structure.

CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

The Turkish version of the MidSTEP is a valid and reliable instrument. The measurement tool can confidently be used in undergraduate midwifery clinical education.

Experiences of preceptorship in Singapore: A qualitative exploratory study of preceptors' experience in precepting nursing students during pre-registration of clinical placement in an acute hospital

BACKGROUND

Preceptors play an important role in teaching and guiding nursing students to transit to the role of registered nurses. Nursing students are trained to acquire the skills and knowledge in providing good quality care to patients. However, the preceptors in the clinical area may face challenges in providing care to their patients in addition to their preceptor role. It is vital to explore and gain insights on the preceptorship experience to better understand their challenges and facilitate their preceptorships and the learning experience of the nursing students.

AIMS

This study explored the preceptors' experience to understand their challenges and support received in the facilitation of the preceptorship and learning experience of the nursing students in an acute care hospital in Singapore.

METHODS

Semi-structured interviews were conducted from June to October 2021 with ten registered nurses working in an acute hospital. Thematic analysis was conducted.

RESULTS

Three main themes emerged from the thematic analysis: (1) preceptor-student relationship; (2) barriers and challenges to successful preceptorship; and (3) outcomes of successful preceptorship.

CONCLUSIONS

This study provided valuable insights in the experience of the preceptors in Singapore. Recommendation for nursing management and leaders to establish support system in promoting recognition of preceptors, establish dialog sessions between stakeholders. Nursing education to provide support and to review the efficacy of the current preceptorship program to identify correlation with successful precepting experience for both preceptors and nursing students. Despite challenges faced by the preceptors, their experience had been positive and they are committed in precepting the nursing students.

Development and testing of the Midwifery Perceptions and Assessment of Clinical Teaching (MidPaACT) tool

OBJECTIVE

Develop and test a tool to measure midwives' perceptions of their role in preceptoring midwifery students.

DESIGN

A multi method exploratory study design was used.

POPULATION

Preceptor midwives from three maternity units in south-east Queensland Australia.

METHODS

A three-phase process was used: item generation; expert review; psychometric testing including content analysis of qualitative responses. The survey was online or paper-based and included demographic details, the Clinical Preceptor Experience Evaluation Tool (CPEET) role subscale and draft tool. A focus group discussion explored the open-ended responses.

FINDINGS

A large sample of preceptors (n = 164, 64.2 % response rate) participated. Factor analysis revealed a two-factor structure with 24 items accounting for 40.2 % of variance. The mean total score of the Midwifery Perceptions and Assessment of Clinical Teaching (MidPaACT) tool was 103.31 (SD = 9.47). The scale was reliable (Cronbach's alpha 0.89) and valid. Test-retest reliability showed moderate to excellent temporal stability across the scale and subscales. Measures of concurrent validity showed little agreement with the CPEET tool. Qualitative analysis revealed the way midwives were taught as students had a powerful influence on their approach to teaching in practice.

CONCLUSION

This tool is specifically designed to assess midwifery preceptors' perceptions of their role in student learning in practice. Psychometric testing of the MidPaACT tool confirms its reliability and validity.

IMPLICATIONS FOR PRACTICE

Midwifery preceptors are a key influence on the development of students' capability as a midwife. Midwives' perceptions of their proficiency in student learning are under-reported. The MidPaACT tool provides a reliable and valid means of measuring preceptors' perceptions and identifying areas for future educational and workforce improvement.

A systematic review of preceptor's experience in supervising undergraduate nursing students: Lessons learned for mental health nursing

BACKGROUND

Preceptorship in nursing has been a valued concept in nursing. Speciality area such as mental health nursing has a massive gap in research study. To develop sturdy mental health nursing workforce, it is necessary to conduct more studies.

AIM

This literature review aims to explore preceptor's experience in precepting undergraduate nursing students in mental health.

DESIGN

Systematic review of literature.

METHODS

The systematic review was conducted from January 2021 to August 2021. Population of the studies included Registered Nurses supervising nursing students in the clinical area. Only studies conducted in English were included. A systematic search using EBSCO Host databases, CINAHL Complete, MEDLINE APA Psycinfo & APA PsycArticles, has been used in this review paper. Papers were also selected from the citation reference of included papers. The new version of the PRISMA 2020 guidelines used to represent the process of selection of papers has been incorporated as part of this review. The final set of data included 14 original papers meeting the eligibility criteria which involved quantitative (n = 5), qualitative (n = 4) and mixed-method studies (n = 5).

RESULT

Results were presented under three major themes: time-consuming, lack of recognition and need extra support. Further research is required in the mental health clinical setting to effectively explore the impact of relationships between preceptors and the preceptees.

CONCLUSION

Preceptors reported supervising students in the clinical area has many benefits. However, some challenges they raised were increase in workload, requiring some guidance and acknowledgement from the organization.

Effects of preceptors' mentoring function on novice nurses' self-efficacy and organizational commitment: A cross-sectional study

AIMS

This study investigated novice nurses' perception of the effects of preceptors' mentoring function on their self-efficacy and organizational commitment.

BACKGROUND

Nursing mentoring is a mutually beneficial relationship between more and less experienced nurses. In nurse education, mentoring is a powerful tool that can be used for a successful transition from a novice to an experienced nurse.

DESIGN

This descriptive study used a cross-sectional design.

METHODS

A questionnaire survey was conducted with 160 novice nurses from Korean general hospitals who had been working for less than a year after completing their preceptorship.

RESULTS

The preceptors' mentoring function as perceived by the novice nurses was 3.87, self-efficacy of the novice nurses was 3.71 points, and the organizational commitment was 3.46 out of 5 points. The results of the multiple regression analysis showed that mentoring function significantly affected novice nurses' self-efficacy (β = 0.50, p < 0.01) and organizational commitment (β = 0.54, p < 0.01). Further, the preceptorship training period had a significant effect on organizational commitment (β = 0.13, p < 0.05).

CONCLUSION

Preceptors' mentoring function, as perceived by novice nurses, affected their self-efficacy and organizational commitment.

Nurse practitioner preceptor education to increase role preparedness

BACKGROUND

The public has become aware of the need for nurses and nurse practitioners in primary care with the widespread public health crisis. As the need for nurses and nurse practitioners grows, there is a need for the clinical educator and preceptor. However, preceptors have noted barriers to precepting such as time constraints, lack of preceptor role education, and role preparedness.

LOCAL PROBLEM

Currently, neither preceptor role development nor education has been implemented within a local institution. Preceptor vocalization led the charge for preceptor role development education within the institution.

METHODS

This quality improvement project focused on the preceptor role preparedness and education. A convenience sample was recruited from a large, diverse academic institution. The modified Clinical Supervision Self-Assessment Tool-Skills was utilized to determine the effectiveness of online education in preceptor role preparedness.

INTERVENTIONS

An online, self-directed, evidence-based preceptor education webpage with easily reproducible information related to collaborating with students and faculty situations. Literature, such as the One Minute Preceptor, Ask, Tell, Ask, and engaging student scenarios, was included from the literature review. A voice-recorded PowerPoint summarizing the webpage was included with a transcript for accessibility.

RESULTS

A paired t-test was used to assess the mean differences between the preintervention and postintervention periods. The results indicated the online preceptor education was effective.

CONCLUSIONS

Preparing nurse practitioner preceptors for their roles benefits the health care system. An online, self-directed, evidence-based preceptor education webpage can be beneficial in future preceptor education planning.

The lived experience of being an undergraduate midwifery student in the neonatal unit

OBJECTIVE

The objective of this study is to examine the experience of undergraduate student midwives in the neonatal unit.

BACKGROUND

Clinical experience is an essential component of education for the development of competent midwives. Literature has highlighted the pivotal effects of precepting and how it contributes to student experience. Although there is a plethora of research examining undergraduate student midwives' experience, to our knowledge this is the first study exploring their experience in the neonatal unit.

DESIGN

Based in phenomenology, eight semi-structured interviews were conducted producing rich data.

METHODS

Following informed consent and ethical approval, post transcription, the data were coded using Colaizzi's (1978) framework.

RESULTS

Significant themes and sub-themes emerged such as course design, environmental experience, sources of stress and preceptor experience. The student experience very much depends on the preceptor, how busy the environment is and if appropriately staffed.

CONCLUSIONS

Based on these findings there are suggested recommendations including adjusting the timing and length of the placement and how to improve the environment based on the preceptor-student relationship. Also, suggestions on how consistency and communication can be improved are proposed.

Factors that influence the preceptor role: a comparative study of Saudi and expatriate nurses

OBJECTIVES

The aim of this study was to compare expatriate and Saudi nursing staff's perceptions of factors that influence their role as preceptors of nursing students.

METHODS

Descriptive comparative study using a self-administered survey was completed by a convenience sample of eligible nurses (n=285). It was conducted in five different hospitals within the Ministry of Health in the Kingdom of Saudi Arabia.

RESULTS

Most preceptors were expatriate nurses (70.5%), while Saudi preceptors represented only 29.5%. The findings show that there is a difference between Saudi and expatriate nurses in their perception of the role, that cultural factors influence the role of expatriate preceptors and that organisational factors influence both groups.

CONCLUSIONS

Expatriate preceptors felt that there were cultural obstacles that hindered their role. These findings will contribute to the development of a more contemporary and culturally sensitive preceptorship model.

Systematic review of tools to measure preceptors' perceptions of their role in undergraduate health clinical education

OBJECTIVE

Evaluate tools used to measure preceptors' perceptions of their role in the clinical education of health undergraduate students.

BACKGROUND

Measurement of preceptors' perceptions of their role in students' learning in practice lacks consistency. The preceptor role makes an important contribution to quality clinical education.

DESIGN

A systematic literature review informed by PRISMA Guidelines.

DATA SOURCES

Major databases CINAHL, ProQuest, Nursing and Allied Health, Medline, Health Reference Centre, Joanna Briggs Institute, PsychInfo and Google Scholar were searched.

REVIEW METHODS

The search strategy yielded a total of 166 papers. Screening for inclusion resulted in 28 papers for critical appraisal and review.

RESULTS

Twenty-two individual tools were identified. Fourteen were named. Nine tools were new, study-specific and untitled. Eight tools were informed by previous research. A third of studies were appraised as being of good quality. A lack of consistency in measures, use of small convenience samples and reliance on self-reported outcomes limited the generalisability of findings.

CONCLUSIONS

Two tools were suitable measures of preceptors' perceptions of their role or an appropriate measure for preceptor effectiveness in students' learning in practice. These tools were tested on the nursing profession only. Ensuring quality in clinical education requires consideration of experiences of key stakeholders and standard measurement of perspectives, effectiveness and preparedness to achieve quality clinical learning outcomes for students.

The Challenges of Precepting Undergraduate Nursing Students in Malawi

PURPOSE

Malawi trains registered nurses as clinical preceptors to facilitate quality clinical teaching to nursing students. The concept of preceptorship is new in Malawi, and as such data about its contribution and challenges are scanty. It is for this reason that this study was undertaken to explore the challenges that preceptors face as they teach students.

METHODS

This exploratory-descriptive qualitative study was conducted at Malawi's four major referral hospitals utilised by nursing training institutions as clinical sites. A sample of 12 participants was purposively selected to provide data regarding challenges encountered during preceptorship activities. In-depth interviews were conducted in order to collect data on challenges experienced by these facilitators. The data were later categorised and analysed into themes.

RESULTS

From the analysed data, three key themes emerged including preceptorship as time-consuming, lack of support from faculty members and lack of teamwork among preceptors.

CONCLUSION

The study concluded that preceptors face several challenges that affect the quality of clinical teaching. The study recommends that there should be an improvement in the working relationship among those involved in clinical teaching to enhance clinical learning experiences among student nurses. It also recommends that more registered nurses should be trained as preceptors to improve the student-preceptor ratio.

Preceptorship of Student Nurses in Ghana: A Descriptive Phenomenology Study

Background

Preceptorship plays an integral part in the clinical training of nursing and midwifery students, especially in high-income countries where it is a well-accepted concept. However, in Ghana, most nurses and midwives do not view preceptorship as part of their role.

Aim

The aim of this study was to explore the lived experiences of preceptorship of student nurses and the challenges confronting the preceptorship role.

Methods

A descriptive phenomenological study was conducted with 22 purposively selected preceptors aged 34 to 56 years from five clinical placement sites in the Cape Coast Metropolis in the Central Region of Ghana. Most of the participants had been preceptors for two to 18 years. In-depth interviews were conducted with the aid of a semistructured interview guide and analysed by qualitative thematic analysis inspired by Braun and Clarke's description of the method.

Results

The essence of the phenomenon has been captured in three main themes: (1) being excited about the role as it offered opportunities to learn and build relationship with students. (2) Encountering challenges including student's unwillingness to learn, absenteeism, and disrespect and also lack of interest of staff to assist students, time constraints, workload, burnout, parallel schedules of preceptors, and large student numbers, and (3) the need for effective collaboration between educational institutions and hospitals.

Conclusions

Though preceptors were excited about precepting student nurses, the challenges associated with it are multidimensional which requires effective collaboration between educational institutions and clinical placement sites.

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.

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.

Exploring the internship experiences of Swedish final term student midwives: A cross-sectional survey

Today, student midwives in Sweden spend half of their midwifery education at various internships. Practice reality demonstrates that there is an insufficient number of preceptors for the students, and the workload is demanding. Therefore, the present study aimed to explore the experiences of final term Swedish students during their midwifery internship and whether other paedagogical learning experiences beyond the apprenticeship model were included. A cross-sectional survey was distributed to 288 final year midwifery students at all universities offering the midwifery programme in Sweden. This paper focuses on open-ended questions, which were answered by 108 students, and analysed inductively via thematic analysis. Students described an intensive period with pressure during their internship. They expressed a desire for fewer parallel tasks and a better-structured internship. Students revealed that it was both a challenge and stressful to be under constant high performance while practising clinically. Furthermore, students described feelings of competition towards fellow peers in regard to attaining the final number of 50 assisted births. As to the paedagogical methods, the classical preceptorship model with a one-to-one student-preceptor relationship was predominately used. Preceptors were perceived as crucial role models. However, this learning experience was considered suboptimal for learning in the event where preceptors were not engaged or felt insecure regarding their knowledge, or if the preceptor was changed. For the students, the most optimal setting would be if preceptors were selected, trained, and supported in their role to supervise students, instead of being assigned any available preceptor, who was, at times, not a midwife.

Should we use preceptorships in undergraduate nursing education?

BACKGROUND

Clinical learning experiences are the cornerstone of undergraduate nursing education as they allow students to apply theory to practice and help them develop as competent practitioners who are prepared for the realities of diverse, complex, and ever-changing practice environments.

PROBLEM

The traditional clinical teaching model, where small groups of students work with educators who are on-site facilitating learning, has numerous issues and thus there have been calls for reform. This Creative Controversy focuses on one reform option, the alternative clinical teaching model of preceptorships, which has gained popularity in recent years.

APPROACH

Current evidence surrounding preceptorships in undergraduate education was examined and critiqued.

CONCLUSION

Despite their popularity, there is a lack of robust evidence surrounding preceptorships and the motivations for using this model remain questionable. Future study is needed so preceptorships are implemented according to evidence-based teaching practices and not clouded by inappropriate motivations. The author challenges readers to question their practices and work to positively contribute to the science and practice of nursing education.

Becoming a nurse preceptor, the challenges and rewards of novice registered nurses in high acuity hospital environments

Precepting is a common and expected role of nurses in clinical settings worldwide. This research explored novice nurse's experiences of precepting undergraduate nursing students in high-acuity hospital environments. An interpretive study was undertaken with 12 novice nurses (<3-years of post-registration clinical experience), who were precepting nursing students. Data was collected through focus groups and thematically analysed. The zone of proximal development theory was applied to understand the relationship of learning that occurs between students and nurses. Three themes were identified. Firstly, participants established that precepting students enhanced their own self-development, and was a rewarding role, that not only developed the student into a nurse, but provided opportunities for the novice nurse to learn. Second, precepting was both challenging and rewarding. The challenges involved the student, the context, and the preceptors' own teaching and learning skills, resulting in feelings of frustration and conflict between nursing care and preceptor roles. Third, precepting was an expectation of both the nursing role and from senior nurses. At times, the participants felt overwhelmed and drained, particularly when having students that challenged them on multiple consecutive shifts. Participants identified the need for guidance and support from more capable peers to develop confidence while precepting nursing students.

The competence of nurse mentors in mentoring students in clinical practice - A cross-sectional study

BACKGROUND

Nurses play an important role in developing the competence of nursing students and acting as role models for students during clinical practice placements. Nurses need diverse competence to successfully mentor nursing student.

OBJECTIVES

This study aimed to describe and explain nurse mentor competence in mentoring nursing students in clinical practice settings based on self-evaluation, as well as identify different mentor profiles.

DESIGN

This study employed a cross-sectional, descriptive design involving a self-administered electronic version of the Mentor Competence Instrument.

SETTINGS

The study population included nurse mentors from all five university hospitals in Finland.

PARTICIPANTS

Through random sampling, 3355 nurse mentors were invited to take part in the study in 2016.

METHODS

Data was collected using Mentors Competence Instrument, which consists of 63 items structured in 10 mentoring competence categories.

RESULTS

Mentors (n = 576) evaluated their level of competence in various categories as middle- to high-level. They evaluated reflection during mentoring and identifying a student's need for mentoring the highest, whereas student-centered evaluation and supporting a student's learning process were rated lowest. Three distinct profiles of mentor competence were identified. These profiles differed in evaluation of mentoring competence level, previous participation in mentoring education, and time spent on reflective discussions with students.

CONCLUSIONS

According to their profiles, mentors have diverse needs for support in building their mentoring competence. We suggest that healthcare organizations should provide nursing mentors with education that is based on their individual levels of mentoring competence. Nurses should also be encouraged to use time for reflective discussion with students during clinical practice.

Adaptation and validation of the clinical supervision self-assessment tool among registered nurses

BACKGROUND

Clinical supervision of pre-registration nursing students has become an integral role of the registered nurse. The Clinical Supervision Self-assessment Tool relating to knowledge (CSAT-Knowledge) and the individual's skills (CSAT-Skills) of clinical supervision and comprising of 30 items each originally is widely used for nurses in Australia. However, the psychometric properties of this tool have not been previously reported.

OBJECTIVE

To adapt the Clinical Supervision Self-Assessment Tool for nurses and to investigate the psychometric properties of the modified tool to measure registered nurses' knowledge and skills regarding supervising pre-registration nursing students.

DESIGN

Instrument adaptation and psychometric testing.

PARTICIPANTS/SETTINGS

A convenience sample of 229 registered nurses in a tertiary teaching hospital in Australia.

METHOD

A two-phase prospective study was conducted. Phase 1 involved the modification of the Clinical supervision Self-Assessment Tool, content validity and pilot testing of the modified version. Phase 2 included the psychometric testing of the modified Clinical Supervision Self-Assessment Tool (mCSAT-Knowledge; mCSAT-Skills).

RESULTS

The mCSAT-Knowledge and mCSAT-Skills comprised of 30 items each. The content validity of the mCSAT was considered satisfactory based on the feedback from the expert panel. Results of the exploratory factor analysis supported a three-factor structure identified as: evaluating clinical learning; facilitating clinical learning and problem solving. The internal consistency was high with a Cronbach's alpha values >0.90. The construct validity was supported as nurses who had undertaken clinical supervision training demonstrated significantly higher clinical supervision knowledge and skills scores than those had no training.

CONCLUSIONS

The findings provide empirical support for the modified Clinical Supervision Self-Assessment Tool as a valid measure of registered nurses' knowledge and skills regarding the clinical supervision of pre-registration nursing students. The tool requires further psychometric testing in different samples of nurses to enable validation in other settings.

In-depth Knowledge of the Role of the Clinical Mentor

OBJECTIVES

This work sought to unveil the meaning expressed by clinical nurses by being mentors for students from the nursing internship level.

METHODS

Phenomenological research. In-depth interviews were conducted with nine clinical nurses from a hospital in Santiago de Chile, who participate as mentors of nursing students in their last stage of university formation.

RESULTS

Four comprehensive categories were obtained with their respective units of meaning by nursing: 1) vocation and gratification, 2) personal and professional challenge, 3) big responsibility, and 4) transmission of experience.

CONCLUSIONS

Clinical mentorship is a relevant experience in the professional lives of nurses, which implies overcoming challenges, self-training, and delivering the best of oneself, for the purpose of training future professionals prepared to practice nursing integrally.

Norwegian midwives' opinion of their midwifery education - a mixed methods study

BACKGROUND

Midwifery education in Norway has undergone radical reforms in the past few decades. In 2004, the compulsory year of paid internship was removed from the requirement to become an authorised midwife. Since then, authorisation as a midwife depends on the successful completion of a two-year full-time academic course, consisting of 50% clinical practice and 50% theoretical education. Our objective was to examine midwives' opinion of their Norwegian midwifery education in relation to their midwifery practice, comparing those educated with internship to those without.

METHODS

We performed a mixed-methods study based on data from a nationwide cross-sectional survey. A sample of 547 midwives completed a postal questionnaire, autumn 2014. Midwives were asked how they were educated, how their education prepared them for practice (multiple choice) and to freely comment on their midwifery education. Thematic analysis and descriptive and comparative analysis was used. Data sets were analysed independently and jointly interpreted.

RESULTS

Of our sample, 154 (28.2%) were educated through a two-year midwifery education without internship, while 393 (71.8%) had a one-year midwifery education with internship. Compared to midwives who had internship, midwives without were four times more likely to report that their education did not, or only partially prepare them for their work as a midwife. The association lost its significance when adjusted for experience as a midwife. According to the qualitative data, the primary reason for the association was insufficient clinical practice during education. Relevant clinical placement, ample practice time with good preceptorship and internship were proposed as methods to prepare for practice as a midwife. The theory-practice gap was highlighted as another hindrance to being prepared for practice.

CONCLUSIONS

Academisation of the midwifery education has resulted in newly qualified midwives feeling less prepared for practice. Midwives would have liked more time for clinical practice and simulation training of core midwifery clinical skills included in the education. Midwifery educations need to explore ways to achieve a good balance between practice and theory. Workplaces need to explore alternative ways to internship to assist new graduates to become confident midwives with a strong midwifery identity.

Graduate nurses' experiences of mental health services in their first year of practice: An integrative review

New graduate nurses have reported negative experiences in mental health settings, particularly during the transitional period of practice. Previous research has focused on addressing the undergraduate preparation of nurses for practice instead of the experiences and outcomes of the transitional period. Recently, there has been growing interest in exploring the experiences of graduate nurses in transition and the implementation of promising interventions to facilitate new graduates' assimilation to practice. Despite these initiatives, the overall shortage of mental health nurses continues to rise, and graduates still report negative experiences in the mental health setting. The purpose of this study was to identify and explore the experiences of new graduate nurses in mental health services in their first year of clinical practice. An integrative review was conducted with 22 studies sourced from the CINAHL, PubMed, Scopus, and PsychINFO electronic databases, as well as through hand-searching the literature. Literature review findings have highlighted negative clinical experiences and increased attrition from mental health services for graduate nurses. These experiences were closely linked with the changes in the training of mental health nurses, role ambiguity, inadequate clinical preceptorship, encountering the reality of mental health services, and the role of health services in transitioning graduate nurses into clinical practice. Established research into organizational cultures demonstrates that negative organizational outcomes result from negative workplace experiences. Therefore, further research into new graduate nurses' experiences of mental health nursing and its culture might clarify the reasons why they might not be attracted to the discipline and/or are leaving early in their career.

The perspectives of preceptors regarding clinical assessment for undergraduate nursing students

AIM

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

BACKGROUND

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

METHODS

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

FINDINGS

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

CONCLUSIONS

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

IMPLICATIONS FOR NURSING AND/OR HEALTH POLICY

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

The development and validation of the Clinical Teaching Behavior Inventory (CTBI-23): Nurse preceptors' and new graduate nurses' perceptions of precepting

BACKGROUND

Few studies have examined the perceptions of clinical teaching behaviors among both nurse preceptors and preceptees.

PURPOSES

To develop a Clinical Teaching Behavior Inventory (CTBI) for nurse preceptors' self-evaluation, and for new graduate nurse preceptee evaluation of preceptor clinical teaching behaviors and to test the validity and reliability of the CTBI.

METHODS

This study used mixed research techniques in five phases. Phase I: based on a literature review, the researchers developed an instrument to measure clinical teaching behaviors. Phase II: 17 focus group interviews were conducted with 63 preceptors and 24 new graduate nurses from five hospitals across Taiwan. Clinical teaching behavior themes were extracted from the focus group data and integrated into the domains and items of the CTBI. Phase III: two rounds of an expert Delphi study were conducted to determine the content validity of the instrument. Phase IV: a total of 290 nurse preceptors and 260 new graduate nurses were recruited voluntarily in the same five hospitals in Taiwan. Of these, 521 completed questionnaires to test the construct validity of CTBI by using confirmatory factory analysis. Phase V: the internal consistency and reliability of the instrument were tested.

RESULTS

CTBI consists of 23 items in six domains: (1) 'Committing to Teaching'; (2) 'Building a Learning Atmosphere'; (3) 'Using Appropriate Teaching Strategies'; (4) 'Guiding Inter-professional Communication'; (5) 'Providing Feedback and Evaluation'; and (6) 'Showing Concern and Support'. The confirmatory factor analysis yielded a good fit and reliable scores for the CTBI-23 model.

CONCLUSIONS

The CTBI-23 is a valid and reliable instrument for identifying the clinical teaching behaviors of a preceptor as perceived by preceptors and new graduate preceptees. The CTBI-23 depicts clinical teaching behaviors of nurse preceptors in Taiwan.

Perceptions of preceptorship in clinical practice after completion of a continuous professional development course- a qualitative study Part II

Background

For health care professionals, clinical practice is a vital part of education, and in several countries, teaching is a regulated part of the role of nurses and health care staff. The added responsibility of taking on the teaching of students during clinical practice; thus, balancing clinical and educational demands, might lead to feelings of stress and burnout. Being a skilled and experienced professional is not automatically linked to being a skilled educator as teaching of a subject is a completely different story. Preceptors who participate in educational initiatives are better prepared to address challenges and are more satisfied with the preceptor role. The aim of the current study was to evaluate preceptors’ experiences of preceptorship in clinical practice after completion of a credit bearing continuous professional development course on advanced level.

Methods

This was a small-scale interpretative qualitative study drawing data from focus group interviews and written accounts from reflective journals. Data were analysed through the process of naturalistic inquiry.

Results

Our findings show that the participants, who took part in and completed the CPD course, had developed skills and competences they believed to be necessary to drive pedagogical development at their respective workplaces. This is illustrated by the main category Leading educational development and explained by four sub-categories: 1/ increased ability to give collegial support; 2/ increased trust in one’s abilities; 3/ increased emphasis on reflection; and 4/ increased professional status.

Conclusions

A well-structured program based on the needs of preceptors and developed in partnership between educational and clinical settings seems to be successful in terms of preceptors’ perceived increase of their competence, abilities and professional status. What seems to be missing, not only from the current study but also from previous research, is to what extent properly prepared preceptors impact on student learning and this needs to be further investigated.

Midwifery students learning experiences in labor wards: a grounded theory

BACKGROUND

The labor ward is an important and challenging learning area for midwifery students. It is there the students learn in authentic complex situations, in intimate situations, with potential risk for the life and health of mothers and their babies.

OBJECTIVE

The aim of this study was to explore the main concern expressed by midwifery students in labor wards and how they handled this concern.

DESIGN

A longitudinal study based on grounded theory methodology was used. The participants were 10 postgraduate midwifery students, from a University College in Norway. Data were gathered and analyzed throughout the 2-year postgraduate program, in the students first, third and fourth semesters. Every student was interviewed three times in a total of 15 single and three focus-group sessions.

FINDINGS

The grounded theory of "building relationships" explains how students dealt with their main concern: "how to gain access to learning experiences". This theory consisted of three strategies; a) controlling vulnerability, b) cultivating trust and c) obtaining acceptance.

CONCLUSION

Clarifying discussions involving midwives and students may facilitate the process of building relationships and contribute to confident learning. Students appreciate it when the midwives initiate discussions about acute situations and state that a novice may perceive labor and childbirth as more frightening than an experienced midwife would.

The role performance of public health nurses as clinical instructors in Japan

AIM

To investigate the factors associated with the role performance of public health nurses as clinical instructors in Japan.

BACKGROUND

Newly graduated public health nurses in Japan have competencies that are below the minimum requirements of the Ministry of Health, Labour and Welfare because of their limited clinical experience in undergraduate clinical education. Public health nurses play crucial roles in the clinical practicum and their role performance as clinical instructors is a key to successful learning outcomes.

METHODS

This study targeted public health nurses in governmental public health centres and those who had gained experience as an undergraduate clinical instructor for nursing students. A self-administered questionnaire was distributed to a national sample of 1467 public health nurses. Data were collected from July 2011 to September 2011.

RESULTS

In total, 722 of 1467 questionnaires were completed (nurse age 22-64 years). Of the participants, almost half (49%) strongly disagreed (3%) or disagreed (46%) that they had confidence in their role as a clinical instructor, and preparation programmes for clinical instructors had been attended by just 262 (36.3%). Years of experience as public health nurses, previous attendance of preparation programmes, viewing their role positively, professional identity and professional competency were significantly associated with performance. Logistic regression analysis revealed that nurses with higher role performance scores had higher self-confidence, greater interests in their role and higher professional identity.

CONCLUSIONS

The self-confidence and interests of public health nurses in their role as clinical instructors as well as their professional identity were found to be significant predictors of their role performance as clinical instructors.

IMPLICATIONS FOR NURSING PRACTICE AND EDUCATION

The factors identified in our investigation can be used to predict effective clinical instructors and to develop preparation programmes to enhance their confidence and interests and potentially increase their role satisfaction.

Evaluation of an inter-professional training program for student clinical supervision in Australia

BACKGROUND

As a response to an Australian shortage of clinical health, nursing, and medical placements, Commonwealth Government funding has been directed to expand student training opportunities and increase the competence and number of available clinical supervisors. This paper evaluates the application of a particular supervision training model for this purpose. It considers the model's suitability and relevance across professions and its impact on supervisory knowledge, skills, and values as well as the intention to supervise students.

METHODS

The design, delivery, and evaluation of a series of one-day introductory student clinical supervision training workshops for allied health disciplines, nursing, and medicine are considered. Participants evaluated Proctor's model of clinical supervision, which was expanded by the trainers to incorporate diversity and power relations in student supervision.

RESULTS

Evaluation results suggest that adapting Proctor's model for student clinical supervision is relevant across a broad range of health disciplines and clinical areas. Participants from 11 health professions reported that the training improved their knowledge, skills, and values and expanded their willingness to accept student clinical placements. The outcomes are suggestive of enhanced clinical supervision intent, capacity, and capability.

CONCLUSIONS

The student supervision training improved participants' confidence in their clinical supervision skills. The findings suggest that the training has the potential to extend capacity and capability for student supervision across health professions and in Health Workforce Australia's identified priority areas of mental health, community health, rehabilitation, private practice, and non-government organisations. Findings also indicate that these gains are reliant on health organizations developing and sustaining cultures of learning.