Nursing students' perceptions of factors influencing their learning environment in a clinical skills laboratory: A qualitative study

Exploring challenges and perceptions in the learning environment: an online qualitative study of medical students

BACKGROUND

The teaching and learning environment (TLE) in medical schools is critical for shaping the outcomes and competencies of graduates. Research on TLE has highlighted its influence on student learning approaches and outcomes, yet gaps remain, particularly in qualitative insights, especially in Saudi Arabian contexts. This study aims to explore the students' experiences and perceptions of the TLE in a new medical college.

METHODS

This qualitative study consisted of a total of five focus group discussions (3consequtive sessions for male group and two for female group) conducted virtually using the Zoom videoconferencing application. All the discussion sessions took place during a lockdown because of the COVID-19 pandemic between December 2020 and February 2021. Each session lasted for 45-60 min. Each group was formed of 4-5 students from different academic levels in the Majmaah medical school, which was established 10 years ago and is located in a small city. After "verbatim transcription" of the sessions was made, a framework thematic analysis of the data was performed using the NVivo software.

RESULTS

The study results revealed that various elements, such as educational content, faculty roles, and personal factors, collectively influenced the students' educational experiences. The students valued educational relevance and autonomous decision-making. The multifunctional role of faculty as mentors, evaluators, and resource providers was considered essential in enhancing academic experiences. Additionally, there was an evident need to improve the physical learning environment and facilities to adapt to emerging educational needs. These results align with existing literature, emphasizing the integration of theory and practice and the significant impact of faculty roles in academic experiences.

CONCLUSION

The findings suggest that medical colleges should involve students more in decision-making related to their education and ensure the practical relevance of the educational content. Establishing open communication channels between students and faculty who act as mentors and evaluators is also essential. Furthermore, enhancing supportive infrastructures, such as mental health and financial services, and promoting extracurricular activities are crucial for fostering a more effective and nurturing learning environment.

Barriers and Facilitators to Clinical Supervision in Ghana: A Scoping Review

Background

Clinical supervision involves the professional relationship between an experienced and knowledgeable clinician and a less experienced clinician in which the experienced clinician provides support toward the skills development of the less experienced one. The concept, structure, and format of clinical supervision vary in various jurisdictions and is influenced by the availability of resources, the training needs of supervisees, and organizational structures.

Aim

The aim of this scoping review was to explore, map out and synthesize the available literature on the facilitators and barriers to clinical supervision in Ghana.

Methods

The methodological framework developed by Arksey and O'Malley and modified by Levac et al. for scoping reviews, and the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews were used to ensure a coherent and transparent reporting of literature. A systematic search was conducted in PubMed, CINAHL, Scopus, Medline, and Google Scholar using key words and key terms. Articles published between January 1, 2000, and February 28, 2023, were included in the review.

Results

The initial search across all the databases yielded 208 results. Two independent reviewers completed both the title and abstract, and full text screenings. A third reviewer helped to resolve all discrepancies that arose during the screening process. The review included 20 articles and generated four themes: clinical supervision as a collaborative effort, feedback mechanism, training and adaptation, and challenges with implementation.

Conclusion

Findings from this review highlight that healthcare professionals in Ghana valued clinical supervision. However, the implementation of clinical supervision is faced with individual and systemic challenges. There is the need for on-going collaboration between educational and clinical institutions to develop modalities that promote clinical supervision in Ghana.

Development of a Tool to Determine Excellence in the Provision of Physical Therapist Clinical Education: A Modified Delphi Study

OBJECTIVE

The purpose of this study was to create a Site of Excellence in Clinical Education (SECE-PT) tool with the essential criteria used to determine excellence in the provision of physical therapist clinical education at a clinical site using a consensus-building approach.

METHODS

The development of the SECE-PT tool was divided into 2 parts. Part 1 involved the development of an initial set of proposed criteria, whereas part 2 employed a modified Delphi approach for consensus building. Purposive selection and snowball sampling techniques were used to recruit clinical instructors, recent graduates, site coordinators of clinical education, and directors of clinical education who met the inclusion criteria for the modified Delphi study. Three web-based survey rounds were used to achieve consensus, defined as a mean score of ≥7 on the 11-point Likert scale. The first round gathered demographic information on participants and collected information about clarity and redundancy in the criteria provided, the second gathered information once again about clarity and redundancy on the revised criteria provided, and the third asked participants to rate how essential it was for a site of excellence to demonstrate each of the final criteria.

RESULTS

A total of 123 participants, equally representing clinical and academic perspectives, completed the demographic survey and round 1. Ninety-four participants completed round 2, and 80 participants completed the third and final round. Consensus revealed that 44 criteria were deemed essential for a SECE-PT to demonstrate.

CONCLUSION

This study provides a measure to evaluate clinical sites providing clinical education. The SECE-PT tool should be widely adopted to evaluate the quality of the clinical site providing the education to student physical therapists.

IMPACT

The SECE-PT tool can be used by clinical sites for self-assessment to examine aspects of their clinical education programs and determine whether parts of their program should be further developed. This can provide a framework for discussion and collaboration between clinical and academic partners, as well as regional consortia.

Effectiveness of feedback type on performance quality and satisfaction of nursing student: A comparative interventional study

BACKGROUND

Although feedback has a major impact on teaching and learning, the type and way of providing it can have diverse effects. The purpose of this study was to compare the effect of two types of verbal and written feedback on nursing students' performance quality and satisfaction.

MATERIALS AND METHODS

This experimental study, that carried out in 2019, has a crossover design. The participants included 30 bachelors of science in nursing at Shushtar Faculty of Medical Sciences, who were assigned to two groups of 15. The first group received first verbal feedback and then written, during basic nursing skills training. The second group received first written feedback and then verbal. At the end of each half of the training sessions, students' performance and their satisfaction were assessed by, researchermade observational checklists, and a satisfaction questionnaire, respectively. Data were analyzed using SPSS16 software and analyzed using Chi-square and paired t test. Significance level < 0.01 was considered.

RESULTS

The mean scores of students' performance in the stages of verbal and written feedback were 15.7 ± 2.5 and 17.7 ± 2.3, respectively. Written feedback was more effective in students' performance (P = 0.001) and students were more satisfied with this type of feedback (P = 0.001).

CONCLUSIONS

According to the present study, using written feedback can improve the quality of students' performances and is associated with high satisfaction. Thus, professors should pay more attention to feedback in their educational processes and use different types of feedback, especially written feedback, in line with the context.

Nursing students' experience of workplace violence in clinical practice: A qualitative systematic review

AIMS

To systematically identify, appraise and synthesise qualitative studies investigating Registered Nurse students' (RNS) experiences of workplace violence (WPV) while on clinical placement. It is expected that the literature review findings will guide the development of targeted programs and policies to address WPV against RNS.

BACKGROUND

WPV affects RNS during clinical placements as they are vulnerable to violence due to their limited experience and skills to challenge abusive behaviour. In this review, RNS are students enrolled in a Bachelor of Nursing program to become registered nurses and exclude students who are enrolled in nursing program that does not lead to registration as a registered nurse. For example, enrolled in nursing programs and postgraduate nursing programs. RNS are chosen for their scope of practice and the training requirements. RNS reported experiencing WPV mainly from colleagues, staff, teachers, doctors and supervisors, which resulted in leaving nursing practice, impacting students' progression and healthcare systems. This review examines all types of violence RNS face irrespective of the abuser.

METHODS

A qualitative systematic review of existing literature was conducted through a comprehensive database search of eight databases MEDLINE, CINAHL, Web of Science, Scopus, Embase, Cochrane Central and ProQuest. Furthermore, reference lists of included studies were searched to identify further research. English language qualitative primary studies of any study design were searched from inception to 6th June 2022 and included if they met the inclusion criteria. Double review process utilised from screening until data synthesis reported according to PRISMA. JBI critical appraisal tools were used to assess the studies, and data extraction utilised JBI QARI tool and screened for credibility and confidence in findings.

RESULTS

A total of 18 studies met the inclusion criteria, and the studies were conducted in nine countries. Five main themes relating to RNS experiences of WPV while on clinical placement were identified, including: 'Types of workplace violence', 'Perpetrators', 'Causes', 'Consequences' and 'Management of workplace violence'.

CONCLUSIONS

This qualitative systematic review provides new and significant knowledge in understanding the phenomenon of WPV experienced by RNS while on clinical placement.

RELATIVE TO CLINICAL PRACTICE

This review highlights the unwillingness of RNS to reach out to instructors or clinical placement leaders in many situations and identifies avenues of support and awareness that are crucial to empower and enabling students to seek support.

Experiences of nurse educators regarding the use of the clinical skills laboratory at the School of Nursing in the Free State province

Background

Integration of theory to practice by student nurses is a challenge in most training institutions accredited by the South African Nursing Council (SANC). Nurse educators require a fully equipped and functional clinical skills laboratory to impart clinical competency knowledge to student nurses.

Aim

The purpose of this study was to understand the experiences of the nurse educators in teaching clinical skills to student nurses using the clinical skills laboratories.

Setting

The study was conducted at the School of Nursing in the Free State province in 2021.

Methods

A qualitative descriptive design was employed. Purposive sampling was used to select participants for the study. Unstructured one-on-one interviews were conducted with 17 nurse educators until data saturation was reached. Data were analysed thematically.

Results

The three major themes that emerged during data analysis and were discussed to make recommendations of the study are as follows: clinical skills laboratory environment; human and material resources; financial constraints.

Conclusion

This study revealed that there is a need for the use of the clinical skills laboratory by nurse educators to teach clinical practice to student nurses. Therefore, it is imperative that the study recommendations be considered for implementation to improve the use of the clinical skills laboratory.

Contribution

The importance of integrating theory to practice by using the clinical skills laboratory during clinical practice teaching by nurse educators will be understood.

Experiences of Nursing Instructors Related to Safety Issues Using Students as Practice Models in Laboratories: A Focus Group Study

AIM

Nursing school students perform invasive (i.e., injection, venipuncture) and/or non-invasive procedures (i.e., giving a bed bath and back massage) on each other to master these skills, and nursing instructors reported related safety issues. This study aimed to explore nursing instructors' experiences concerning their students' psychological and physical safety when using students as practice models in nursing skills laboratories.

METHODS

A qualitative design using focus group interviews and thematic analysis was employed. Two semi-structured focus group interviews were conducted with a purposive sample of eight instructors with experience in teaching nursing skills in laboratories. This study was evaluated by the Institutional Review Board at Eulji University (EU18-51) in the Republic of Korea.

RESULTS

Three main themes emerged to describe nursing instructors' safety-related experiences when using students as practice models in nursing skills laboratories: (1) a dilemma between the experimental learning of students and the need to keep students safe, (2) perception related to psychological safety, and (3) an inadequate safety reporting system.

CONCLUSIONS

When instructors consider using students' bodies to practice nursing skills, they experience a dilemma between the students' experimental learning and the need to keep them safe. Thus, methods to maximize student learning and student safety guidelines should be developed.

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

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

Midwifery students' experiences of objective structured clinical examinations: A qualitative evidence synthesis

OBJECTIVES

To identify and synthesise the evidence of midwifery students' views and experiences of Objective Structured Clinical Examinations (OSCEs).

DESIGN

A qualitative evidence synthesis was undertaken using Thomas and Harden's synthesis methods and reported according to the ENTEREQ guidelines.

DATA SOURCES

PubMED, CINAHL Plus, Embase, ERIC, PsycINFO, Social Science Citation Index (via Web of Science) and Scopus were searched from inception to 19th February 2020 and an updated search was performed on 12th May 2021 to identify qualitative and mixed method studies, reporting qualitative data of undergraduate midwifery students' views and experiences of OSCEs.

REVIEW METHODS

Studies were independently screened by title and abstract according to a predetermined inclusion and exclusion criteria. Full text review was then conducted independently by two authors. Studies providing qualitative data on undergraduate midwifery students' views and experiences of OSCEs during their midwifery registration education programmes were included. Quality appraisal was performed using the Critical Appraisal Skills Programme (CASP) tool. Data synthesis was performed using Thomas and Harden's thematic synthesis method.

RESULTS

Eleven studies were identified and included. Thematic synthesis identified 13 descriptive themes which translated into four analytical themes that represented midwifery students' views and experiences of OSCEs: the preparation phase, the assessment phase, the feedback phase and the translation phase.

CONCLUSIONS

This synthesis offers insight into undergraduate midwifery students' views and experiences of OSCEs and how they are experienced across four phases. This is determined to be a useful structure to guide midwifery educators and researchers in their consideration of the student experience of OSCEs in the future. Midwifery students in this synthesis reported high levels of nervousness, anxiety, and stress during the OSCE process. The findings reveal that there are a number of controllable factors impacting on midwifery students' feelings of safety in the assessment environment, and that these should be addressed to maximise the advantages that the OSCE has to offer in terms of learning and preparation for clinical practice.

Unveiling how Clinical Nursing Education can be Improved in Northern Ghana: The Perspectives of Key Informants

Introduction

Clinical nursing education is an important component of the professional development of nursing students. Key informants such as nursing lecturers, nurse managers and clinical placement coordinators play an essential role in clinical education.

Purpose

The purpose of the study was to explore the perspectives of key informants on how the current state of clinical nursing education in Northern Ghana can be improved.

Methods

The study used an exploratory qualitative design. Sixteen participants were purposively selected and data were collected through face-to-face individual interviews. Data were analysed using framework analysis.

Findings

The study findings indicate that clinical nursing education can be improved by decreasing the overcrowding of students in the clinical setting, decreasing the theory-practice gap and providing relevant material resources in the clinical facilities. Also, nursing education institutions can improve clinical nursing education by equipping the skills laboratories, engaging an adequate number of lecturers, and carrying out clinical accompaniment.

Conclusion

There is a need to improve clinical education through collaboration between nursing education institutions and clinical facilities. Effective collaboration will ensure the planning of clinical placement to avoid overcrowding, provision of continuous professional development programmes for preceptors and improvement in clinical supervision. Also, the provision of material resources in skills laboratories and clinical facilities to enhance clinical teaching should be given priority.

Nursing students first experience on high fidelity simulation: A phenomenological research study

AIM/OBJECTIVE

This study aimed to explore the perceptions of nursing students towards their first experience with high-fidelity simulation (HFS) in a Spanish university.

BACKGROUND

Simulation experiences are becoming more popular in nursing education, allowing students to practice clinical skills before encountering actual patients.

METHODS

A phenomenological approach was used. Sixteen in-depth, semi-structured, qualitative one-on-one interviews were conducted among second-year undergraduate nursing students who had completed a scheduled HFS training program. The interview transcripts were analyzed using Colaizzi's phenomenological method.

RESULTS

Four themes were identified: "Learning through simulation"; "Acting like a nurse instead of being a student"; "Facilitators and barriers of learning"; and "Transition from simulation to reality."

CONCLUSION

This study provides support for including high-fidelity simulation programs in the nursing curricula to enhance student preparedness for clinical placements.

Virtual reality simulations in nurse education: A systematic mapping review

OBJECTIVES

Simulation-based learning is widely used in nurse education, including virtual reality (VR) methods which have experienced a major growth lately. Virtual reality offers risk free and contactless learning. Currently, little is known about what topics of nursing are adopted for VR simulations and how their design meets various educational goals. This review aims to scope existing articles on educational VR nursing simulations, and to analyse approaches from didactic and technical perspectives.

METHOD

A systematic mapping review following the PRISMA-ScR guideline and PICo search strategy was conducted. Peer reviewed articles in English and German were searched across Scopus, CINAHL, PsycINFO, PSYNDEX, PsycARTICLES, PubMed, ERIC and The Cochrane Library. Studies had to include at least one immersive head-mounted display VR simulation in the field of nursing education. Data extraction and analysis was performed in a narrative, graphical and tabular way.

RESULTS

Twenty-two articles were identified. There is a large variety in the use and definition of VR simulation for educational purposes. Simulations were classified into four main educational objectives: procedural skills training to improve technical knowledge and proficiency; emergency response training that focusses on confidence; soft skills training that teaches empathy; and finally, psychomotor skills training. Various approaches and simulation designs were implemented to achieve these educational outcomes. A few of them were highly innovative in providing an immersive experience to learn complex tasks, e.g. auscultation, or foster empathy by mimicking life with dementia.

CONCLUSIONS

Despite an increase in the use of state-of-the-art VR nursing simulations, there is still a paucity of studies on immersive HMD based VR scenarios. Researchers designing educational VR packages need to be clear on terminology. In order to make full use of VR, designers should consider including haptic devices to practise psychomotor skills and include social interaction to teach soft skills.

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.

The relationship of sleep quality among internship nurses with clinical learning environment and mental stress: a cross-sectional survey

BACKGROUND

Previous evidence has supported an association between sleep quality and psychological stress. However, the association between internship nurses' sleep status and its relevant factors is poorly understood.

OBJECTIVE

The aim of this study was to investigate sleep quality and its related factors in clinical learning environment and mental stress.

METHODS

A cross-sectional survey was conducted by three instruments: Clinical Learning Environment, Supervision, and Nurse Teacher Evaluation Scale (CLES + T), Stress Rating Scale for practicing nurses (SRS) and Pittsburgh Sleep Quality Index (PSQI).

RESULTS

A total of 508 (91.86%) of 553 students experienced poor sleep quality. The structural equation model showed a correlation of the PSQI with the CLES + T (r = -0.21, p < 0.001), a correlation of the PSQI with the SRS (r = 0.32, p < 0.001), and a correlation of the SRS with the CLES + T (r = -0.22, p < 0.001). Linear regression analysis showed that education (B = -0.56, p < 0.001), willingness to engage in nursing after graduation (B = -0.75, p < 0.001), pedagogical atmosphere in the ward (B = -0.05, p < 0.001) measured by the CLES + T, workload (B = 0.11, p = 0.01), interpersonal relationships (B = -0.12, p = 0.03), and conflicts between study and work (B = 0.12, p < 0.001) on the SRS were significant factors influencing the PSQI.

CONCLUSIONS

Poor sleep quality is common among internship nurses and it's affected by clinical environment and mental stress. It's necessary to apply more tailored education programs to promote nursing development.

From Learning on Mannequins to Practicing on Patients: Nursing Students' First-Time Experience of Clinical Placement in Jordan

Introduction

Although clinical nursing placement is an indispensable component of student nurses' education, data on students' first clinical experiences is scarce in developing countries.

Objectives

The study aim is to uncover nursing students' first-time clinical placement experience and identify related influencing factors in Jordan.

Methods: Focus group discussions (n=4) were used.

Results

The results showed that the transition from learning with mannequins to practicing on real patients in the clinical placement involved both effective learnings through hands-on practice to dealing with clinical challenges. Students perception of nursing ranged from positive comments such as “humanistic” and “nursing almost medicine” to negative images such as “nursing is all about bedside care” and “nursing has poor social status.”

Conclusion

Students' experience in their first clinical placement is multifaceted, and incorporation of student's perspective in the first clinical placement is a crucial component of educational planning.

Being an international nursing student in Turkey: A qualitative study

PURPOSE

The purpose of this study is to explore the perspectives of international nursing students in Turkey on their learning experience.

DESIGN AND METHODS

Qualitative semi-structured individual interviews and focus group interviews were used to explore nursing students' perspectives on their learning experiences in Turkey. The research population comprised 10 international students.

RESULTS

The students expressed fear of being rejected by patients in a clinical setting, as well as feelings of isolation and discrimination. They feel foreign and experience the typical prejudice against their color and language.

PRACTICE IMPLICATIONS

Educators should take language and cultural differences into consideration and should listen to international students regarding education methods. Teachers of international students, both academic and clinical, need to be cognizant of the "otherness" of international students.

Exploring factors that motivate nursing students to engage in skills practice in a laboratory setting: A descriptive qualitative design

Objectives

The aim of this study was to explore factors that motivate students to engage in skills practice in a laboratory setting, and to identify their motivation types and the regulatory styles.

Methods

Semi-structured interviews were conducted with 23 nursing students from three universities between November 2017 and January 2018. A thematic analysis was used to identify factors associated with students’ motivation to engage in skills practice in a laboratory. The types and the regulatory styles of student motivation were identified based on the self-determination theory.

Results

Seven motivating factors were identified. These factors included the students’ desire “to acquire the skills necessary to work as a nurse”, the “desire to improve skills in preparation for clinical practicum”, and their felt “obligations to patients as a nurse”. Moreover, “the impetus to study arising from the objective evaluation of oneself and others” and “wanting to pass the skills examination” motivated the students to engage in skills practice. A “learning environment that facilitates students’ learning” and the “supportive involvement of educators” facilitated their learning. Based on the self-determination theory, the students were found to embrace extrinsic motivation with four regulatory styles of motivation, namely integrated, identified, introjected, and external regulation.

Conclusions

Nurse educators should understand the motivating factors of students, and help students embrace a more internally controlled motivation by helping them envision their future careers as nurses, and by fostering their ethical duty to care for patients.

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.

Effect of clinical teaching behaviours on transition shock in graduate nurses

AIM

This study aimed to explore the impact of preceptor clinical teaching behaviours on transition shock in graduate nurses using bi-directional feedback between graduate nurses and clinical preceptors and to assess preceptor clinical teaching behaviours.

DESIGN

This was a descriptive cross-sectional study.

METHODS

This study was conducted from January-February 2019. Participants included graduate nurses (N = 117) and clinical preceptors (N = 908) from a major public tertiary hospital in Western China.

RESULTS

Overall level of transition shock of graduate nurses was moderate (mean = 89 SD  17.54). Transition shock level of graduate nurses rose with the increasing of time in clinical work. Intensive care unit graduate nurses suffered the strongest transition shock, whereas surgery graduate nurses suffered the least. Graduate nurses thought that clinical preceptors were best at evaluation and feedback, whereas clinical preceptors thought they were best at showing concern and support. The primary factors associated with transition shock in graduate nurses were the time admitted to the hospital, feedback, and evaluation, use of appropriate teaching strategies, and showing concern and support, explaining 63.5% of the total variation in transition shock in graduate nurses.

CONCLUSION

In Western China, where the development of economic and medical conditions lag, transition shock is a major obstacle to the professional development of graduate nurses and clinical teaching behaviours is the key to overcoming transition obstacles. However, the serious shortage of nurses makes it difficult to not only complete heavy clinical nursing work but also to undertake the teaching of students and graduate nurses. The clinical teaching system is influenced by many factors. Focusing on clinical teaching behaviours and transition shock in graduate nurses will provide valuable data for future intervention studies.

IMPLICATION

The findings of this study will be of interest to managers at all levels and will enable them to support graduate nurses by engaging in excellent clinical teaching behaviours. In the clinical teaching process, giving more feedback and evaluation, improving the ability of using appropriate teaching strategies and focusing on the physical and mental health of graduate nurses may effectively decrease transition shock of graduate nurses and reduce the turnover rate.

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.

Using "Knowing That" and "Knowing How" to Inform Learning of Peripheral Vein Cannulation in Nursing Education

Background Peripheral vein cannulation is one of the most common invasive practical nursing skills performed by registered nurses. However, many registered nurses lack competence in this practical skill. Learning peripheral vein cannulation associated with successful placement and maintenance is not well understood. Framework Ryle's ways of knowing, "knowing that" and "knowing how", can be used during peripheral vein cannulation learning to guide development and competence in this practical skill. Aim The aim of the article was to provide an overview of Ryle's ways of knowing and to make recommendations for best practices for nurse teachers and nurses teaching students peripheral vein cannulation. Conclusion Ryle's ways of knowing can assist nursing students in their learning and development of peripheral vein cannulation.

Students' perceptions of teaching factors that demotivate their learning in lectures and laboratory-based skills practice

Objectives

The objective of this paper is to report students' perceptions of factors that demotivated their learning in lectures and laboratory-based skills practice settings.

Methods

A total of 23 students were recruited from the Bachelor of Nursing courses at three Japanese universities, using purposive sampling. A semi-structured interview was conducted with each participant between November 2017 and January 2018 to elicit their perceptions about which aspects of the teaching context demotivated their engagement in learning. The results were analyzed using thematic analysis.

Results

Three themes were generated: a restrictive environment, discouraging attitudes and discouraging teaching approaches.

Conclusions

To prevent students from experiencing demotivation, teachers in the nursing faculty need to manage learning resources more effectively, create a quiet and focused atmosphere to allow students to concentrate, and be enthusiastic about teaching. They also need to add value to their classes, help students to follow lectures, and ensure that the workload they give their students is appropriate.

Clear skies ahead: optimizing the learning environment for critical thinking from a qualitative analysis of interviews with expert teachers

INTRODUCTION

The learning environment refers to the physical, pedagogical, and psychosocial contexts in which learning occurs and critically influences the educational experience of trainees in the health professions. However, the manner in which individual faculty explicitly organize the educational setting to facilitate learning of essential competencies such as critical thinking deserves more examination; lack of attention to this component can undermine the formal curriculum. The purpose of our study was to examine how faculty shape the learning environment to advance their learners' development of critical thinking.

METHODS

We took a constructivist grounded theory approach using the framework method for qualitative content analysis. Data were derived from interviews conducted with 44 faculty identified as skilled teachers of critical thinking at eight academic health professions institutions.

RESULTS

Three major themes emerged regarding participants' descriptions of their experiences of how they optimized the learning environment to support critical thinking: 1) Setting the atmosphere (establishing ground rules, focusing on process rather than answers, and building trust), 2) Maintaining the climate (gently pushing learners, tolerating discomfort, and adjusting to learner level), and 3) Weathering the storm (responses to challenges to learning critical thinking, including time and effort, negative evaluations, and resistance to effortful learning).

DISCUSSION

An optimal learning environment for critical thinking was actively created by faculty to establish a safe environment and shared understanding of expectations. Understanding how to produce a conducive learning climate is paramount in teaching essential topics such as critical thinking. These findings have potential utility for faculty development initiatives to optimize the learning environment.

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.

A conjoint analysis of the acute and critical care experiential learning preferences of Baccalaureate student nurses

With the increasing need for competent nurses specializing in acute and critical care, educators must consider the needs and preferences of students in designing experiential learning programs. This cross-sectional, choice-based conjoint analysis determined the acute and critical care experiential learning preferences of student nurses. From March to July 2016, 213 randomly-selected student nurses from a higher education institution in Manila, Philippines were surveyed and ranked 20 choice bundles with 5 selected attributes of the experiential learning program. Results showed that duration of unit exposure (48.73%) and group structure (7.46%) were the most and least valued attributes, respectively. Additionally, student nurses prefer an experiential learning program that lasts for 1 week (21 h) per unit (utility = 0.93), has a stay-in instructor (utility = 0.30), encourages full student involvement (utility = 1.08), deploys 2-3 students per group (utility = 0.09), and provides both single program and on-going unit orientation (utility = 0.52). Part-worth utilities of duration of unit exposure (t = 3.65, p = 0.0001) and group structure (t = 3.46, p = 0.001) differed between gender. With a model explaining the acute and critical care experiential learning preferences of student nurses, nursing institutions can restructure their clinical placement to maximize positive learning.

Characteristics of a critical care clinical placement programme affecting critical care nursing competency of baccalaureate nursing students: A structural equation modelling

AIM AND OBJECTIVES

To evaluate and determine the characteristics of a critical care clinical placement programme affecting the critical care nursing competency of baccalaureate nursing students.

BACKGROUND

The increase in global demand for competent critical care services and human resources translates to an educational focus in preparing students for their eventual role as critical care health professionals. Albeit clinical placement in critical care units can promote competency, evidence supporting such claim remains inadequate.

DESIGN

Cross-sectional, descriptive correlational design.

METHOD

Employing structural equation modelling, 236 randomly selected baccalaureate nursing students from a clinically intensive university in the Philippines were recruited from January-March 2016. A three-part online survey, composed of the robotfoto, Critical Care Nursing Rotation Evaluation Questionnaire, and Intensive and Critical Care Nursing Competence Scale, was completed. The STROBE checklist was followed in reporting this study.

RESULTS

Five characteristics of clinical placement were extracted as follows: sufficient clinical exposure, adequate area orientation, supportive clinical instructor, diversified medical cases and supplemental learning resources. Four characteristics affected critical care nursing competency and built a good model (χ² /df = 1.52; comparative fit index = 0.94; parsimonious normal fit index = 0.77; root mean square error of approximation = 0.047). Adequate area orientation had the most diverse influence on all competency domains, while supportive clinical instructor had the strongest positive influence on critical care nursing skill (β = 0.30, p = 0.005).

CONCLUSION

The model highlights the characteristics of a critical care clinical placement programme which influences critical care nursing competency among nursing students. It emphasised the importance of a supportive clinical instructor and adequate area orientation in promoting critical care nursing skills and values and attitude.

RELEVANCE TO CLINICAL PRACTICE

The proposed model highlights the role of clinical instructors and appropriate orientation which provides impetus in improving the clinical placement design to maximise competency development.

The efficacy of interprofessional simulation in improving collaborative attitude between nursing students and residents in medicine. A study protocol for a randomised controlled trial

Background: Effective collaboration among health professionals is an essential component to ensure quality of care. Many adverse events experienced by patients are attributed to misunderstanding or poor communication among members of the interprofessional team. Interprofessional simulation is a learning strategy used to improve collaboration and facilitate communication between medical and nursing students. Aim of the work: To determine the efficacy of educational program based on high-fidelity interprofessional simulation aimed at improving collaborative attitude. Method: For this purpose, a protocol for a planned single-center, non-blinded and Randomized Controlled Trial (RCT) was chosen. The present has been approved by the Ethics Committee of Area Vasta Emilia Nord (Italy) (n° 479/2018). All students attending the second and third year of nursing and all resident physicians in anesthesia, reanimation, intensive care and pain management of University of Modena and Reggio Emilia, will be recruited and randomly assigned to two groups. The Experimental Group (EG) will receive an educational intervention based on high-fidelity simulation and the Control Group (CG) will attend a traditional classroom lesson. Jefferson Scale of Attitudes toward Physician-Nurse Collaboration (JSAPNC) and Readiness for Interprofessional Learning Scale (RIPLS) will be administered before and after the educational program in both the EG and CG. Conclusion: Expected outcomes is that, at the end of the study, nursing students and resident physicians who participated in the interprofessional simulation show significantly higher levels of interprofessional collaboration compared to the CG, evaluated through the JSAPNC.

Assessment of Nursing Student Confidence Using the Clinical Skills Self-Efficacy Scale

Student self-efficacy related to clinical skills is important to successful performance in the clinical setting. This pilot study was designed to evaluate the confidence levels of junior and senior nursing students in performing selected nursing skills, using the Clinical Skills Self-Efficacy Scale. A descriptive cross-sectional design was used in which participants completed an online survey. Findings indicate that senior students demonstrated higher self-efficacy than juniors; their experiences and confidence related to performing specific clinical skills varied across groups. Strategies to improve students' clinical skills learning specific to the laboratory and clinical settings are addressed.

Status of Nordic research on simulation-based learning in healthcare: an integrative review

Background

Based on common geography, sociopolitics, epidemiology, and healthcare services, the Nordic countries could benefit from increased collaboration and uniformity in the development of simulation-based learning (SBL). To date, only a limited overview exists on the Nordic research literature on SBL and its progress in healthcare education. Therefore, the aim of this study is to fill that gap and suggest directions for future research.

Methods

An integrative review design was used. A search was conducted for relevant research published during the period spanning from 1966 to June 2016. Thirty-seven studies met the inclusion criteria. All included studies were appraised for quality and were analyzed using thematic analysis.

Results

The Nordic research literature on SBL in healthcare revealed that Finland has published the greatest number of qualitative studies, and only Sweden and Norway have published randomized control trials. The studies included interprofessional or uniprofessional teams of healthcare professionals and students. An assessment of the research design revealed that most studies used a qualitative or a descriptive design. The five themes that emerged from the thematic analysis comprised technical skills, non-technical skills, user experience, educational aspects, and patient safety.

Conclusion

This review has identified the research relating to the progress of SBL in the Nordic countries. Most Nordic research on SBL employs a qualitative or a descriptive design. Shortcomings in simulation research in the Nordic countries include a lack of well-designed randomized control trials or robust evidence that supports simulation as an effective educational method. In addition, there is also a shortage of studies focusing on patient safety, the primary care setting, or a combination of specialized and primary care settings. Suggested directions for future research include strengthening the design and methodology of SBL studies, incorporating a cross-country comparison of studies using simulation in the Nordic countries, and studies combining specialized and primary care settings.

Electronic supplementary material

The online version of this article (10.1186/s41077-018-0071-8) contains supplementary material, which is available to authorized users.

Nursing and midwifery students' perception of learning enablers and gains in the first semester of their BSc programmes: A cross sectional study

BACKGROUND

The student experience in the first year of university is fundamental to successful adaption to the higher education environment and shapes student engagement with their chosen degree. Students' feedback on this experience is essential when designing or reviewing curricula.

OBJECTIVES

The aim of this study was to explore students' perceptions of their learning gains to identify factors that support student learning and identify elements that need improvement if specific learning needs are to be met.

DESIGN

A cross sectional descriptive study.

SETTING

A large urban university in Ireland that provides undergraduate nursing and midwifery degree programmes.

PARTICIPANTS AND METHODS

The study was conducted using the Student Assessment of Learning Gains (SALG) questionnaire. This instrument consists of a series of closed questions which explore perceived student gains in skills, cognitions and attitudes. The questionnaire was adapted for a semester rather than a module evaluation. The tool also includes a series of open questions inviting students to comment in each section.

RESULTS

Students (n = 206) positively evaluated teaching and learning approaches used. The greatest enablers of learning were clinical skills laboratory small group teaching and support followed by online learning materials and multiple choice formative assessment questions. They reported gains in knowledge, generic skills development and an increase in confidence and enthusiasm for their chosen career.

CONCLUSION

The feedback gained in this study provides valuable knowledge about the elements that support nursing and midwifery students learning and highlights areas that require attention. This is particularly useful for faculty who are involved in curriculum review and enhancement and in student engagement and retention.

Action research and millennials: Improving pedagogical approaches to encourage critical thinking

BACKGROUND

This article examines the effects of intergenerational diversity on pedagogical practice in nursing education. While generational cohorts are not entirely homogenous, certain generational features do emerge. These features may require alternative approaches in educational design in order to maximize learning for millennial students.

METHOD

Action research is employed with undergraduate millennial nursing students (n=161) who are co-researchers in that they are asked for changes in current simulation environments which will improve their learning in the areas of knowledge acquisition, skill development, critical thinking, and communication. These changes are put into place and a re-evaluation of the effectiveness of simulation progresses through three action cycles.

RESULTS

Millennials, due to a tendency for risk aversion, may gravitate towards more supportive learning environments which allow for free access to educators. This tendency is mitigated by the educator modeling expected behaviors, followed by student opportunity to repeat the behavior. Millennials tend to prefer to work in teams, see tangible improvement, and employ strategies to improve inter-professional communication.

CONCLUSION

This research highlights the need for nurse educators working in simulation to engage in critical discourse regarding the adequacy and effectiveness of current pedagogy informing simulation design. Pedagogical approaches which maximize repetition, modeling, immersive feedback, and effective communication tend to be favored by millennial students.

Conditions Affecting the Performance of Peripheral Vein Cannulation during Hospital Placement: A Case Study

Learning practical nursing skills is an important part of the baccalaureate in nursing. However, many newly qualified nurses lack practical skill proficiency required to ensure safe patient care. The invasive skill peripheral vein cannulation (PVC) is particularly challenging to learn and perform. This study explored conditions influencing nursing students' learning and performance of the technical implementation of a PVC during their clinical placement period. A qualitative and descriptive case study design with two students in Norway practicing PVC during their clinical placement was conducted. One student who mastered the vein cannulation was compared with one student who did not. Data were collected in late 2012 using multiple data sources: semistructured interviews, ad hoc conversations, and video recordings. Video recordings of the two students' cannula implementations were used to help clarify and validate the descriptions and to identify gaps between what students said and what they did. Thematic analysis of the transcribed text data enabled identifying themes that influenced skill performance. There were two overall themes: individual and contextual conditions influencing the technical implementation of a peripheral vein cannula. These findings were evaluated in terms of Benner's work on scientific and practical knowledge, defined as “knowing that” and “knowing how.”

Teachers' and postgraduate nursing students' experience of the educational environment in Iran: A qualitative Research

BACKGROUND

The learning environment has a significant role in determining nursing students' academic achievements and course satisfaction. Creating a proper educational environment is therefore necessary for improving the quality of teaching and learning, and for delivering competent graduates to society.

OBJECTIVE

The present study was conducted to explore teachers' and postgraduate nursing students' experience of the educational environment in Iran.

METHODS

This qualitative study uses an inductive approach and conventional content analysis. Data were collected through semi-structured face-to-face interviews with seven PhD students, seven faculty members (directors) and two focus groups comprising of fourteen master's students in total, selected from three major universities in Tehran, Iran.

RESULTS

Seven subcategories were extracted from the data, including the organizational context, interactive climate, teachers' competency, student appreciation, research centeredness, educational guidance and professionalism.

CONCLUSION

The educational environment of postgraduate nursing programs in Iran encompasses different dimensions that can serve as both key points for educational environment evaluators and as guidelines for officials at different levels, to modify the weaknesses and improve the strengths of the system.

Defining and comparing learning actions in two simulation modalities: students training on a latex arm and each other's arms

AIMS AND OBJECTIVES

To explore, describe and compare learning actions that nursing students used during peripheral vein cannulation training on a latex arm or each other's arms in a clinical skills centre.

BACKGROUND

Simulation-based training is thought to enhance learning and transfer of learning from simulation to the clinical setting and is commonly recommended in nursing education. What students actually are doing during simulation-based training is, however, less explored. The analysis of learning actions used during simulation-based training could contribute to development and improvement of simulation as a learning strategy in nursing education.

DESIGN

A qualitative explorative and descriptive research design, involving content analysis of video recordings, was used.

METHODS

Video-supported observation of nine nursing students practicing vein cannulation was conducted in a clinical skills centre in late 2012.

RESULTS

The students engaged in various learning actions. Students training on a latex arm used a considerably higher number of learning actions relative to those training on each other's arms. In both groups, students' learning actions consisted mainly of seeking and giving support. The teacher provided students training on each other's arms with detailed feedback regarding insertion of the cannula into the vein, while those training on a latex arm received sparse feedback from the teacher and fellow students.

CONCLUSION

The teacher played an important role in facilitating nursing students' practical skill learning during simulation. The provision of support from both teachers and students should be emphasised to ensure that nursing students' learning needs are met.

RELEVANCE TO CLINICAL PRACTICE

This study suggest that student nurses may be differently and inadequately prepared in peripheral vein cannulation in two simulation modalities used in the academic setting; training on a latex arm and on each other's arms.

Producing Competent Doctors - The Art and Science of Teaching Clinical Skills

For a doctor to provide medical care with competence, he must not only have knowledge but must also be able to translate that knowledge into action. It is his competence in clinical skills that will enable him to practice safely and effectively in the real world. To ensure acquisition of clinical skills, medical teachers must adopt teaching methods that prioritise observation, practice, feedback; and more practice. We try to elucidate the meaning of clinical skills, the challenges inherent in clinical skills training in India, training models that have shown success in practice and can be adopted in the Indian context, and various techniques to enhance skill-training, including the giving of feedback, which is a critically important component of skills development.

Indicators of undergraduate nursing students' satisfaction with their learning journey: An integrative review

OBJECTIVES

In Australia Bachelor of Nursing programmes are delivered via both internal and distance modes yet there is little knowledge of the indicators of undergraduate nursing students' satisfaction with the learning journey. This integrative review was undertaken to uncover the indicators of undergraduate nursing students' satisfaction with their learning journey.

DESIGN

Integrative review. A review of key papers was undertaken. Only peer-reviewed papers published in scholarly journals from 2008 onwards were included in this integrative review.

DATA SOURCES

Pubmed, CINAHL, Google Scholar, Cochrane, Wiley Online and ProQuest Central databases were searched for relevant papers.

REVIEW METHODS

49 papers were appraised, by a minimum of two team members. CASP tools were used when evaluating qualitative research, systematic and integrated reviews while survey research was evaluated using a tool specifically developed for this purpose by the research team. All tools used to assess the quality of the research studies contained comprehensive checklists and questions relevant for the particular type of study. Data related to these checklists was extracted and the research team appraised the quality of each article based on its relevance to the topic, internal and external validity, appropriateness of data analysis technique(s), and whether ethical considerations were addressed. Seventeen papers were included in the final analysis. Data analysis involved a systematic approach using content analysis techniques.

RESULTS

This integrative review sought to identify indicators of nursing students' satisfaction with their learning journey. Authentic learning, motivation, resilience, support, and collaborative learning were identified by this integrative review as being key to nursing students' satisfaction with their learning journey. Sub themes were identified within each of these themes that assist in explaining nursing students' views of their learning journey.

CONCLUSION

The findings showed that higher satisfaction levels are attained when nursing students feel included and supported during their learning journey.

How can students contribute? A qualitative study of active student involvement in development of technological learning material for clinical skills training

Background

Policy initiatives and an increasing amount of the literature within higher education both call for students to become more involved in creating their own learning. However, there is a lack of studies in undergraduate nursing education that actively involve students in developing such learning material with descriptions of the students’ roles in these interactive processes.

Method

Explorative qualitative study, using data from focus group interviews, field notes and student notes. The data has been subjected to qualitative content analysis.

Results

Active student involvement through an iterative process identified five different learning needs that are especially important to the students: clarification of learning expectations, help to recognize the bigger picture, stimulation of interaction, creation of structure, and receiving context- specific content.

Conclusion

The iterative process involvement of students during the development of new technological learning material will enhance the identification of important learning needs for students. The use of student and teacher knowledge through an adapted co-design process is the most optimal level of that involvement.