Predicting factors of positive orientation and attitudes towards nursing: A quantitative cross-sectional study

Nursing Attitudes Questionnaire: Testing the Psychometric Characteristics of the Italian Version (NAQ-IV)

INTRODUCTION

The image of a nurse is a source of concern due to its impact on recruitment into the profession, political decisions about the profession, and how the image affects nursing practice. For these reasons, one of the long-term challenges is to assess and maintain a favorable public image that respects the utility and value of the nursing profession.

AIM

This study aims to validate an instrument for assessing the image of the nurse as perceived by Italian citizens.

METHODS

A non-probabilistic sample of 564 people participated in the study between 2022 and 2023. Sociodemographic information of the Italian citizens was collected, and the instrument used to evaluate the perceived public image was the Nursing Attitudes Questionnaire (NAQ). The psychometric properties of the Italian version of the NAQ (NAQ-IV) were calculated using Cronbach's alpha, item-total correlations, skewness, and kurtosis. Factor analysis was performed using principal axis factoring and the varimax rotation method.

RESULTS

Factor analysis revealed a four-factor model explaining more than 60.52% of the variance, with the largest variance explained by the "Role and Professionalism" factor (34.08%). The internal consistency calculation showed a Cronbach's alpha of 0.89 for the scale and between 0.88 and 0.89 among the factors; all the items verified the item-total correlation and response variability criteria.

CONCLUSIONS

The NAQ-IV could be a valid tool for assessing the perception of Italian citizens. However, further studies are recommended to evaluate the reliability of the instrument, especially in the evolving professional profile and social health welfare.

Clinical Learning Environment: Perceptions of Palestinian Nursing Students

Clinical learning environment play a vital role in bridging theory with practice, equipping nursing students with essential skills for patient care and support their smooth transition into the nursing workforce. To assess Palestinian nursing students' perceptions of clinical learning environment and supervision. A total of 308 undergraduate nursing students were conveniently recruited from Arab American University-Palestine for this descriptive cross-sectional study. Data collection utilized the Arabic version of the Clinical Learning Environment and Supervision plus Nurse Teacher scale. In general, nursing students expressed positive perceptions regarding their clinical learning environment (M = 130.56 ± 21.03), with the "supervisory relationship" and "role of nurse teacher" scoring highest (M = 3.85 ± 0.82 each). Conversely, the lowest rating was observed for "leadership style of the ward manager" (M = 3.8 ± 0.84). Fourth-year students and those trained in public hospitals showed significantly more positive perceptions (P < .001). Furthermore, students with higher professional satisfaction had more positive perceptions of the clinical learning environment (P < .001). The positive perceptions of Palestinian nursing students underscore the importance of the supervisory relationship and nurse teacher. However, finding suggest an area for improvement in the leadership style of the ward manager, emphasizing the necessity for strengthened partnership between nursing faculties and healthcare facilities. These insights expand our understanding of student perceptions and stress the importance of addressing these concerns to adequately prepare students for professional practice.

Gender and ethnicity's influence on first-year nursing students' educational motivation and career expectations: A cross-sectional study

AIM

Given the apparent link between gender and ethnicity, and the diversity and career opportunities in nursing, this study examined gender and ethnicity's influence on first-year nursing students' educational motivation and career expectations.

DESIGN

Cross-sectional.

METHODS

Through bootstrapped linear regressions, we analysed data on 504 Norwegian first-year nursing students' self-reported educational motivation and career expectations, from the StudData survey at the Centre for the Study of Professions (SPS) at Oslo Metropolitan University (OsloMet).

RESULTS

The sample consisted of 67 (13%) male and 437 (87%) female nursing students. Female students were more motivated compared to male students by professional interest and to pursue a specialization, less likely to assume leadership positions in the future, and more likely to prioritize family and pursue positions in the traditional nursing field. In total, 425 (84%) respondents stated a Norwegian background. Respondents who stated that both of their parents were born in a country other than Norway made up the 79 (16%) students of immigrant background. Those with immigrant backgrounds were more motivated than other students by income, status and flexible working hours and less likely to pursue a specialization or future employment in the nursing field.

The level of competence of graduating nursing students in 10 European countries-Comparison between countries

AIM

To analyse graduating nursing students' self-assessed competence level in Europe at graduation, at the beginning of nursing career.

DESIGN

An international cross-sectional evaluative design.

METHODS

Data were collected in February 2018-July 2019 from graduating nursing students in 10 European countries. Competence was assessed with a validated instrument, the Nurse Competence Scale (NCS). The sample comprised 3,490 students (response rate 45%), and data were analysed statistically.

RESULTS

In all countries, graduating nursing students assessed their competence as good (range 50.0-69.1; VAS 0-100), albeit with statistically significant differences between countries. The assessments were highest in Iceland and lowest in Lithuania. Older students, those with working experience in health care, satisfied with their current degree programme, with excellent or good study achievements, graduating to 1st study choice and having a nursing career plan for future assessed their competence higher.

Nebulous Intentioning - Acute hospital nurses' struggle to deliver core nursing care

AIM

To explore the influences on nursing practice in acute hospital care.

DESIGN

A Classic Grounded Theory study.

METHODS

Data collection (2013-2015) was through interviews and non-participant observations. Analysis was undertaken using constant comparative data analysis and theoretical sampling. Memo writing was used as an aid to understanding and conceptualizing data during analysis. Theoretical coding served to integrate emerging concepts.

RESULTS

This theory explains core nursing as a nebulous intention, an idea which acute care nurses retain throughout each shift, that they will nurse their patients fully when they have the opportunity. It reveals this as the resolution of their main problem which is the constant deferral of core nursing care. This study explains its two sub-core categories, accommodating and integrity eroding.

CONCLUSION

The theory highlights nurses' attitudes towards their role, demonstrated by deferring it to accommodate the work of others, but offers a new perspective on the significant contribution nurses make to the safe and cohesive transition of patients through the acute healthcare system.

IMPACT

The theory adds a new understanding of the unique contribution nurses make to patient health and safety in acute care environments. It also provides insight into nurses' attitudes towards their own professional work. It explains the consequences of attitudes which undermine core nursing when it competes for priority with accommodating. Accommodating indicates a greater workload for nurses than has been previously understood in explaining the activities, additional to core nursing care, which nurses undertake to contribute safety and cohesion to the patient's acute care journey. These new insights suggest a role for managers in recognizing accommodating in decisions about staffing and resources and for educators in improving the profession's regard for its theoretical underpinnings and for its self-image.

A Randomized Control Study on the Effectiveness of Holistic Health Practice Program on a Group of Baccalaureate Nursing Students

Background:

From adolescents transitioning into professional healthcare team members, nursing students need to face different kinds of challenges during their journey of nursing study. Are nursing students ready and prepared to take care of themselves before taking care of others?

Aim:

Few studies were found on the holistic health of nurses in Macao. This study aims to explore the health status of a group of first-year undergraduate nursing students and to investigate whether a holistic health practice program can enhance their holistic health, self-esteem, and self-efficacy after they participate in the program.

Methods:

A randomized control study was used. Students in both the experimental and control groups filled in an online pre-test questionnaire, which consisted of some demographic information and the following measurement tools including, the Health Promotion Lifestyle Profile-II (HPLP-II), the Self-Esteem Scale (ESTEEM), and the General Self-Efficacy Scale (GSES). The experimental participants had to undergo an additional 6-sessions program on holistic health practice. After the intervention, all participants in both groups were invited to complete an online post-test questionnaire, which was the same as the one used in pre-study.

Results:

Results showed that participants’ physical activity was the lowest score in 6 domains, followed by their health responsibility. On the other hand, their spiritual growth scored the highest. The study found that participants who had attended the holistic health practice program had significantly enhanced their holistic health, self-esteem, and self-efficacy.

Conclusion:

This study provided some ground data of the holistic health status of nursing students in Macao. It also demonstrated that the Holistic Health Practice Program is effective in promoting holistic health, self-esteem, and self-efficacy among junior nursing students.

Influencing nursing students' perceptions of community care with curriculum-redesign; a quasi-experimental cohort study

BACKGROUND

The shift in healthcare to extramural leads to more patients with complex health problems receiving nursing care at home. However, the interest of baccalaureate nursing students for community nursing is moderate, which contributes to widespread labour-market shortages. This study investigates the effect of a more 'community-care-oriented' curriculum on nursing students' perceptions of community care.

METHODS

A quasi-experimental quantitative survey study with a historic control group (n = 477; study cohorts graduating in 2015, 2016, and 2017; response rate 90%) and an intervention group (n = 170; graduating in 2018; response rate 93%) was performed in nursing students of a University of Applied Sciences in a large city in the Netherlands. The intervention group underwent a new curriculum containing extended elements of community care. The primary outcome was assessed with the Scale on Community Care Perceptions (SCOPE). The control and intervention group were compared on demographics, placement preferences and perceptions with a chi-square or T-test. Multiple regression was used to investigate the effect of the curriculum-redesign on nursing students' perceptions of community care.

RESULTS

The comparison between the control and intervention group on students' perceptions of community care shows no significant differences (mean 6.18 vs 6.21 [range 1-10], respectively), nor does the curriculum-redesign have a positive effect on students' perceptions F (1,635) = .021, p = .884, R2 = < .001. The comparison on placement preferences also shows no significant differences and confirms the hospital's popularity (72.7% vs 76.5%, respectively) while community care is less often preferred (9.2% vs 8.2%, respectively). The demographics 'working in community care' and 'belonging to a church/religious group' appear to be significant predictors of more positive perceptions of community care.

CONCLUSIONS

Graduating students who experienced a more 'community-care-oriented' curriculum did not more often prefer community care placement, nor did their perceptions of community care change. Apparently, four years of education and placement experiences have only little impact and students' perceptions are relatively static. It would be worth a try to conduct a large-scale approach in combination with a carefully thought out strategy, based on and tying in with the language and culture of younger people.

The orientation and attitudes of intermediate vocational trained nursing students (MBO-V) towards their future profession: A pre-post survey

Students' perceptions of nursing influence recruitment and retention in nursing education. Nursing education in the Netherlands differentiates two levels: Bachelor's (HBO-V) and intermediate vocational (MBO-V) level training, with MBO-V students accounting the majority. To avoid the expected nursing shortages, these students' perceptions of nursing need to be explored. We aimed to examine the orientation and attitudes of MBO-V students towards their future profession and their relation to demographic characteristics. A descriptive survey with a pretest-posttest design was conducted. Newly enrolled MBO-V students completed a questionnaire at the beginning and after five months of education, consisting of the Nursing Orientation Tool, the Nursing Attitude Questionnaire and demographic characteristics. The Wilcoxon signed-rank test, Mann-Whitney U test and regression analysis were used for data analyses. At the first time point, students agreed most with statements related to caring, nursing expertise, advocacy, empathy, and knowledge. After five months, students were more life-oriented, while caring, nursing expertise, advocacy, and empathy decreased. Selecting nursing as a first-choice programme and aiming for a nursing career influenced students' orientation and attitudes towards nursing positively. Being aware of students' orientation and attitudes towards nursing can help nursing educators in recruitment and retention strategies.

Correlation between job security as motivation and career maturity among Japanese nursing students

Objective: For nursing students, career maturity -an individual's readiness to cope with career development tasks and make age-appropriate career decisions- is an essential factor influencing their desire to continue the job after qualifying as a nurse. Although job security as motivation to become a nurse might influence the career maturity of nursing students, it has not been demonstrated. In this study I aimed to elucidate the correlation between job security as motivation and career maturity among Japanese nursing students. Patients and Methods: This study was conducted in 2012, through an anonymous, self-administered questionnaire, on 237 Japanese nursing students. Data on career maturity, job security as motivation, and personal characteristics were collected followed by data analysis using multiple regression. Results: Job security as motivation ("A nursing job is not affected by the economic climate") was significantly correlated with career maturity (β = -0.29; p < 0.001). Conclusion: This study demonstrated that being motivated by job security negatively affects career maturity. Hence, at an early stage, basic nursing educators should identify nursing students with low career maturity by assessing whether they are motivated by job security, and if so, efficiently providing support to improve their career maturity.

Factors underlying perceptions of community care and other healthcare areas in first-year baccalaureate nursing students: A focus group study

BACKGROUND

Despite the increasing labour market shortage of well-educated community nurses, few baccalaureate nursing students choose for a career in community care. Obtaining knowledge of how students perceive healthcare areas early in their education is important to take meaningful steps in counteracting any existing misconceptions with targeted curriculum redesign.

OBJECTIVE

Determination of factors underlying perceptions of healthcare areas in first-year baccalaureate nursing students.

DESIGN

A descriptive qualitative study using focus group inquiry.

METHODS

This study follows up on a large-sample quantitative multicentre survey study. Fourteen first-year nursing students at a university of applied sciences in the Netherlands participated in focus group discussions in October 2014. Transcripts of the discussions were coded by two independent researchers at three levels - open, axial and selective coding - on the basis of two templates. The codes were sorted into categories and assigned to suitable main codes in the templates. The number of sub-codes per category and code were added together.

RESULTS

Eight main themes were formulated, to wit (1) variety and diversity, (2) challenges, (3) improving people's health, (4) collaboration, (5) role models, (6) patient- or environment-based perceptions, (7) self-efficacy and (8) immediate vicinity. Data suggest that first-year students have clear ideas about the characteristics which they consider important in professional practice. Their perceptions do not necessarily reflect the actual situation, as they expect the hospital to possess all desired characteristics while community nursing seems to be undervalued.

CONCLUSION

To remedy students' misperceptions, four recommendations are formulated for curriculum redesign strategies deriving from the eight themes. These recommendations are based on collaboration between school and care organisations as well as on themes related to in-depth knowledge within the educational programme. The interventions will potentially help to strengthen the focus on community care, which will foster a more optimistic and realistic career outlook on this field.

Dreams and disappointments regarding nursing: Student nurses' reasons for attrition and retention. A qualitative study design

BACKGROUND

In the Netherlands, hundreds of students register annually for a nursing programme, but not all of these students manage to complete their training.

OBJECTIVE

The main aim of this study was to examine which factors affect student nurses' decision to leave or complete their programme.

THEORETICAL FRAMEWORK

The study used an exploratory descriptive design, employing a qualitative phenomenological approach.

SAMPLE

Student nurses (n=17) at the beginning of their third year of the four-year Bachelor's programme.

DATA COLLECTION

Data were collected at four Universities of Applied Sciences in the Netherlands, from December 2013 to January 2014. Semi-structured interviews were used to collect the data, using an interview guide.

RESULTS

The main reasons for students to become nurses were the caring aspect, personal experiences with healthcare, role models in their immediate environment, and job opportunities. They had both altruistic and professional perceptions of their profession. Reasons for attrition were strongly related to the training programme and to their clinical placements, in particular the perceived lack of support from mentors and team. Feelings of being welcomed and working in a nice team proved to be more important reasons for completing the programme than the specific clinical field.

CONCLUSIONS

Student nurses started their studies with many dreams, such as caring for people and having the opportunity to deliver excellent nursing care. When their expectations were not met, their dreams became disappointments which caused them to consider stopping and even to leave (attrition). The role of lecturers and mentors seems invaluable in protecting and guiding students through their programme and placements. Optimal cooperation between lecturers and mentors is of paramount importance to retain student nurses in their training programmes.

Nursing students' changing orientation and attitudes towards nursing during education: A two year longitudinal study

BACKGROUND

Previous studies have shown that nursing students' perceptions of nursing change over time. Little research has been undertaken in the Netherlands of students entering nursing programmes and of how they progress.

OBJECTIVES

The aims of this study were to explore whether nursing students' orientation and attitudes towards nursing changed over time, when these changes occurred, and what factors influenced the changes. We also aimed to identify the factors which prompted them to consider leaving their programmes, and what factors affected their motivation to stay.

DESIGN

The study used a longitudinal quantitative design.

PARTICIPANTS

Questionnaires were administered to all students enrolled in a Bachelor's of Nursing programme at four nursing universities of applied sciences in the Netherlands (n=1414). The data for this study were collected during the first two years of the programme, from September 2011 to June 2013. A total of 123 respondents completed the survey each year and this group was used to examine changes over time.

METHODS

At four time intervals respondents completed a survey consisting of 1) the Nursing Orientation Tool, 2) the Nursing Attitude Questionnaire and 3) background characteristics. Non-parametric tests were used to explore changes in factor scores over time.

RESULTS

The results showed an improvement in the students' orientation and attitudes towards knowledge, skills and the professional roles of nurses, while empathic behaviour decreased over time. Although the changes showed non-linear patterns over time, the results showed clear effects between the different time points. The reasons for attrition (24%) proved to be related both to problems with the educational programme and to personal problems. An important motivator for students to stay in the course was their passionate desire to become nurses, suggesting that the positive aspects of a nursing career dominated the problems they encountered.

CONCLUSIONS

Tutors and mentors should pay more attention to the individual perceptions and problems of first and second-year students, both in the classroom and during clinical placements. Knowledge of the students' perceptions from the very beginning could be vital to study success.