"You can't escape it": Bullying experiences of New Zealand nursing students on clinical placement

Workplace Bullying, Hardiness, and Occupational Identity Among Nursing Students: Mediation of Academic Burnout

BACKGROUND

Quality clinical environments are crucial in bridging the gap between theoretical knowledge and practical skills. This study explored the mediating role of academic burnout in relation to workplace bullying experience, stress hardiness, and occupational identity among nursing students during clinical practice.

METHOD

In this cross-sectional study, an online questionnaire was administered to fourth-year nursing students from four universities. Data were collected in March 2023 and analyzed using descriptive statistics, independent t test, one-way analysis of variance, Pearson's correlation coefficient, and PROCESS Macro Model 4.

RESULTS

In the final sample (N = 202), the correlates of occupational identity were stress hardiness and academic burnout; workplace bullying was not statistically significant. Academic burnout completely and partially mediated the relationship between workplace bullying and occupational identity and between stress hardiness and occupational identity, respectively.

CONCLUSION

To strengthen nursing students' occupational identity, active attention and management are required to prevent academic burnout and improve stress hardiness. [J Nurs Educ. 2024;63(9):604-612.].

Factors Affecting Nursing Students' Perception of Workplace Bullying

Workplace bullying is a critical and prevalent issue that causes serious problems in healthcare settings. However, there is little research on the factors affecting nursing students' perception of workplace bullying despite their forthcoming transition into the nursing profession. Therefore, this study aimed to identify the factors related to nursing students' perception of workplace bullying in Korea. A cross-sectional study was conducted among 242 nursing students who had experienced clinical practice. The survey questionnaire included general characteristics, perceived susceptibility and severity of bullying, and perception of workplace bullying. Data were analyzed using multiple regression analysis. In this study, the significant factors affecting nursing students' perception of workplace bullying included bullying experience in clinical practice and the perceived severity of bullying. Therefore, it is crucial for nursing managers and instructors to have a clear understanding of the bullying situations experienced by nursing students during clinical practice. We should promote the perception of workplace bullying through indirect experiences such as systematic education about workplace bullying for nursing students, which may prevent workplace bullying in clinical practice and work environments. Furthermore, a comprehensive and multifaceted approach is necessary to effectively prevent workplace bullying in clinical practice and work environments. This study reveals that systemic and persistent education and intervention to bullying may improve nursing students' perception of workplace bullying and prevent workplace bullying in clinical practice and work environments. Furthermore, this study provides basic data on the prevention and management of bullying in nursing students' clinical practice.

Why nursing students do not report workplace bullying during clinical practice: A mixed methods systematic review

BACKGROUND

Workplace bullying in clinical nurse education significantly threatens students' well-being and professional development. Despite its prevalence, many incidents go unreported, exacerbating the issue and compromising the quality of care. A significant gap exists in the literature regarding comprehensive mixed-methods systematic reviews on unreported bullying incidents among nursing students. This review aims to address this knowledge gap and propose effective strategies to tackle this pervasive problem.

AIM

This mixed-methods systematic review aimed to explore the factors influencing the non-reporting of workplace bullying incidents among nursing students during clinical practice.

DESIGN

Mixed-methods systematic review.

REVIEW METHODS AND DATA SOURCES

An extensive literature search was conducted across ten databases, including PubMed, Cochrane, Embase, Web of Science, CINAHL, PsycINFO, Scopus, Chinese Biomedical, China National Knowledge Internet, and WANFANG, from database inception to November 1, 2023. Google Scholar and reference lists of included studies were also searched. Studies were selected based on eligibility criteria regarding population, phenomena of interest, and context. Two researchers independently assessed study quality, with disagreements resolved by a third reviewer. Relevant data were extracted and synthesized using the Joanna Briggs Institute's convergent integrated approach, ensuring a comprehensive integration of qualitative and quantitative findings.

RESULTS

Twenty-one studies met the inclusion criteria, comprising six qualitative, twelve quantitative, and three mixed-methods studies. Four integrated themes emerged from nursing students' perspectives on reasons for not reporting workplace bullying during clinical practice: (i) fear and concerns related to reporting, (ii) concerns about professional image, (iii) barriers and challenges in reporting, and (iv) perceived ineffectiveness of reporting.

CONCLUSIONS

This systematic review provides valuable insights into nursing students' perspectives on the non-reporting of workplace bullying incidents during clinical practice. Understanding these reasons enables stakeholders to collaboratively develop interventions to create a safer and more supportive environment for nursing students, ultimately enhancing quality care and the well-being of healthcare professionals.

Raising nurse educators' awareness regarding caring pedagogical relationships' barriers to foster inclusive simulation settings: Insights from a phenomenological study

AIM

The purpose of this paper was to shed light on the main barriers to caring pedagogical relationships within simulation centers from the perspective of nursing students and offer targeted strategies to reduce these barriers.

BACKGROUND

A caring pedagogical relationship is a powerful strategy to foster students' learning within simulation settings. However, the development of this relationship could be hindered if nurse educators are not aware of its barriers. Hence, this could affect students' learning and well-being within this academic context. According to our knowledge, no previous research has addressed the question of the barriers to caring pedagogical relationships within the context of simulation.

DESIGN

This study employed a descriptive phenomenological method, entitled Relational Caring Inquiry, to collect and analyze data gathered from 19 students enrolled in an undergraduate nursing program.

RESULTS

This paper focuses on one eidos-theme that emerged from our data analysis and interpretation entitled "Educator's conscientization regarding barriers to the development of a caring pedagogical relationship". According to data analysis and interpretation, this eidos-theme was the most emphasized by research participants. It emerged from the following themes: (a) educators' dehumanizing practices, (b) disruptive and stressful academic context, (c) lack of educators' experiences and (d) educators' disinterest in students' learning.

CONCLUSIONS

Leaving caring pedagogical relationships' barriers unaddressed has shown adverse impacts on students' learning process and their mental and physical well-being. This paper brings to light the main barriers to caring pedagogical relationships and invites educators, managers and nurse leaders to be aware of these obstacles and collectively engage in humanizing nursing education. In other words, we emphasize the impact of these barriers on students' apprenticeship and suggest political actions to build caring and inclusive simulation environments.

STUDY REGISTRATION NUMBER

CERSES-19-050-D.

Effectiveness of interventions for the prevention or management of workplace violence in student nurses during clinical placement: A systematic review

AIM

To systematically investigate the effectiveness of interventions for managing workplace violence experienced by registered nursing students during clinical placement.

DESIGN

A systematic review of experimental studies.

METHODS

The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The key search concepts such as "Nursing students", "Education", "workplace violence", "clinical placement" and "clinical study" were inspected to identify relevant articles (Appendix A). Two independent reviewers completed screening, critical appraisal and data extraction. Due to heterogeneity among the included studies, results were synthesized narratively.

DATA SOURCES

MEDLINE (Ovid), CINAHL (EBSCOhost), Web of Science Core Collection (Clarivate Analytics), Scopus (Elsevier), Embase (Ovid), Cochrane CENTRAL, ERIC (ProQuest), ProQuest Central and ProQuest Social Science Premium Collection were searched from inception to 27th February 2023.

RESULTS

A total of 13 studies were included in this review. The predominant intervention for managing workplace violence experienced by registered nursing students during clinical placements was education. Approaches varied among studies and included didactic teaching, e-learning, role-playing and simulation practice. The included studies showed uncertain improvements in registered nursing students' confidence, coping skills, knowledge, competence and self-efficacy in dealing with workplace violence during clinical placements. Only one study assessed the incidence rate of workplace violence and found that a multi-faceted intervention involving both staff and students decreased the incidence.

CONCLUSION

Given the heterogeneity of educational interventions, the effect of interventions for managing workplace violence during students' clinical placement is uncertain. To address this gap, high-quality, proactive and combined interventions at both institutional and organizational levels are needed.

Interventions to prevent or manage workplace violence against student nurses during clinical placement: a systematic review protocol

OBJECTIVES

The objective of this review is to investigate the effectiveness of workplace violence management or prevention interventions, including strategies, protocols, and policies, to address violence against, and provide support to, registered nursing students (RNS) following incidents of violence during clinical placement.

INTRODUCTION

Workplace violence is a global issue that affects victims' physical and mental health. RNS are especially vulnerable to workplace violence because of their limited work experience and confidence. These students often feel shocked and unprepared when experiencing workplace violence due to limited education and support provided by educational institutions or clinical sites. Workplace violence can lead to anxiety, decreased confidence, and professional attrition. There is a need to systematically synthesize the evidence on workplace violence management and prevention to support nursing students during clinical placement.

INCLUSION CRITERIA

The review will consider studies assessing the effectiveness of interventions to address workplace violence or improve support for RNS. Studies that report on educational interventions or pre-clinical placement strategies and measure the preparedness of students will also be considered. Study designs will be limited to quantitative methods that evaluate intervention effectiveness.

METHODS

Databases to be searched include MEDLINE (Ovid), CINAHL (EBSCOhost), Web of Science Core Collection, Scopus, Embase (Ovid), Cochrane Central, ERIC (ProQuest), ProQuest Central, ProQuest Social Science Premium Collection, and ProQuest Dissertations and Theses Global. Two independent reviewers will screen, review, appraise, and extract data from eligible articles. For data synthesis, studies will be pooled using JBI SUMARI. The GRADE approach for grading the certainty of evidence will be followed and a Summary of Findings will be created.

REVIEW REGISTRATION

PROSPERO CRD42022377318.

Nursing students' experience of bullying and/or harassment during clinical placement

PROBLEM OR BACKGROUND

Bullying is a recognised problem in nursing. Nursing students are particularly vulnerable. Bullying and harassment of nursing students can be detrimental to both students and recipients of care.

AIM

This study aims to identify the incidence and nature of bullying and/or harassment experienced by nursing students in Sri Lanka.

METHODS

A cross-sectional survey consisting of eight demographic questions and 15 items specific to the experience of bullying and harassment was administered to nursing students online.

FINDINGS

A total of 656 students from 26 nursing education institutions in Sri Lanka participated. The majority were female with a mean age of 24.4 years. More than a quarter of respondents reported that they had experienced bullying and/or harassment while on clinical placement, with a further 16.7 % being unsure. Most bullying or harassment (55 %) occurred in hospitals with 29 % experienced in community settings. Registered nurses, including nurse managers and clinical facilitators were the most common perpetrators. Verbal abuse was the most frequent type of behaviour reported.

DISCUSSION

These findings support existing literature that indicates that bullying of nursing students is an international phenomenon. The context of this study provides clues as to how culture may influence the problem. There is a need to better understand bullying and harassment in the environments in which it occurs, in order to identify strategies that can bridge cultures and settings.

CONCLUSION

The incidence of bullying and harassment of nursing students in Sri Lanka is concerning. Further research is needed to identify and evaluate targeted strategies to help prevent negative outcomes in all nursing contexts.

Australian nursing students' experiences of workplace violence during clinical placement: A cross-sectional study

AIM

To identify the nature, degree and contributing factors of workplace violence (WPV) incidents experienced by Australian nursing students during clinical placement.

DESIGN

Descriptive cross-sectional study.

METHODS

Data were collected from 13 September to 25 November 2022. Eligible participants included all nursing students enrolled in nursing degrees at any Australian university who had completed at least one clinical placement. An adapted version of the WPV in the Health Sector Country Case Study survey was used.

RESULTS

A total of 381 nursing students across eight states of Australia completed the survey. More than half of the students had experienced an episode of WPV; patients were the most frequent perpetrators. Personal factors of patients, staff and students, organizational factors and cultural norms within the workplace supported acts of WPV.

CONCLUSION

Student nurses (SNs) most often experience violence from patients during direct care. Patient encounters are the core component of clinical placement. Education providers have a responsibility to effectively prepare students to be able to identify escalating situations and manage potentially violent situations. Registered nurses who supervise students during clinical placement require support to balance their clinical role with student supervision.

IMPLICATIONS FOR THE PROFESSION

Experiencing WPV can negatively impact relationships between students, healthcare professionals and care recipients. This results in personal distress, decreased job satisfaction and potentially the decision to leave the nursing profession.

IMPACT

What already is known: SNs are exposed to WPV during clinical placement.

WHAT THIS PAPER ADDS

More than half the SNs in this study experienced violence inclusive of physical, verbal, racial and sexual harassment. Patients were the predominant perpetrators. Implications for practice/policy: Interventions at individual and systemic levels are required to mitigate WPV.

REPORTING METHOD

This study is reported using the STROBE guidelines.

The mediating role of academic support perception in the relationship between emotional intelligence and bullying behaviours in clinical practice: A cross-sectional study

BACKGROUND

Bullying behaviours experienced by nursing interns in clinical practice are a considerable and serious concern. Understanding the factors that influence such behaviours in clinical practice is crucial for developing effective preventive measures and fostering a supportive learning environment.

PURPOSE

This study aims to investigate the prevalence and influencing factors of bullying behaviours experienced by nursing interns and examine the mediating role of academic support perception in the relationship between emotional intelligence and bullying behaviours in clinical practice.

METHODS

This is a cross-sectional study that used convenience sampling. A socio-demographic information questionnaire, Bullying Behaviours in Nursing Education Scale, Wong and Law's Emotional Intelligence Scale, and Academic Support in the Practicum Scale were used to collect data from nursing interns (n = 813) at seven tertiary hospitals in Changsha, China. Binary logistic regression and mediating analyses were used to explore the factors influencing bullying behaviours in nursing practice and examine the potential mediating role of academic support perception.

RESULTS

The prevalence of bullying behaviours in clinical practice among 813 nursing interns was 82.7 %. Binary logistic regression analyses indicated that attitude toward the nursing profession, emotional intelligence, and academic support perception were significantly associated with bullying behaviours in clinical practice. Academic support perception (β = 0.375, p < 0.001) played a significant mediating role in the relationship between emotional intelligence and bullying behaviours in clinical practice, accounting for 55.7 % of the total effect.

CONCLUSION

Nursing educators and administrators should recognise that improving emotional intelligence and enhancing academic support perception among nursing interns can reduce the occurrence of bullying behaviours in clinical practice.

Prevalence of bullying and its impact on self-esteem, anxiety and depression among medical and health sciences university students in RAS Al Khaimah, UAE

Bullying and peer victimization among medical and health sciences students is a public health issue. This is owing to its detrimental impact and greater risk of psychiatric diseases and psychopathology in childhood, adolescence, and adulthood. As a result, a descriptive cross-sectional research study was conducted to investigate the prevalence of bullying and its influence on self-esteem, anxiety, and depression among medical and health sciences university students in RAS Al- Khaimah, United Arab Emirates. Approximately 369 students from MBBS, BDS, B Pharm, and BSN colleges were selected. The instruments included sociodemographic questions, bullying queries, the Rosenberg Self-Esteem Scale, and the Primary Care Anxiety and Depression Scale. Participants averaged 21.49 ± 2.95. 34.1 % of medical students were bullied. 44.4 % of individuals were called insulting names, making verbal bullying the most common method. The linear regression analysis of bullying data shows that girls (53.2 %) are bullied more than boys (46.8 %). Bullied individuals had a mean score of 43.30 ± 19.74, indicating a higher rate of depression and anxiety. Bullied students had a mean score of 44.62 ± 9.94, indicating lower self-esteem. Significant differences were observed in relation to bullying when considering the variables of the university year, mother's education, and previous experience of bullying (P = 0.002, 0.038, 0.001). It is imperative that universities establish comprehensive protocols to identify instances of such behaviour and provide necessary assistance to victims and their families.

Global prevalence of bullying and associated factors among nursing students during clinical practice: A systematic review and meta-analysis

OBJECTIVE

This meta-analysis aims to estimate the global prevalence of bullying among nursing students during clinical practice and identify associated factors.

DESIGN

Systematic review and meta-analysis.

REVIEW METHODS AND DATA SOURCES

We conducted a comprehensive literature search across ten databases (PubMed, Cochrane, Web of Science, Embase, CINAHL, PsycINFO, Scopus, Chinese Biomedical, China National Knowledge Internet, and WANFANG) from their inception to January 3, 2023. Two researchers independently screened potentially eligible studies, extracted data, and assessed study quality. Data were analyzed using random-effects or fixed-effects models. Subgroup analyses and meta-regression explored the influence of participant and study characteristics on bullying prevalence. Publication bias and sensitivity analyses were also performed.

RESULTS

We included 28 studies (N = 9511) from 13 countries on five continents. The pooled estimate of bullying prevalence among nursing students during clinical practice was 65.60 % (95 % CI 55. 75 to 74.27), with no evidence of publication bias (t = 1.51, p-value = 0.14). Subgroup and moderator analyses highlighted the impact of country, continent, publication year, and assessment tool on bullying prevalence.

CONCLUSION

Nursing students face a high prevalence of bullying during clinical practice. Addressing this issue in nursing education requires prioritizing associated factors, fostering a culture of safety, providing effective training, and promoting individual resilience. These actions can prevent and mitigate bullying, creating a supportive and empowering learning environment for future nurses.

Bullying behaviors and intention to drop-out among nursing students: the mediation roles of sense of belonging and major satisfaction

Bullying in academic settings has long-lasting implications on students' well-being and career prospects, particularly in fields like nursing that require a high level of interpersonal skills and emotional resilience. This study explored the relationships between experiences of bullying and intentions to drop out among Iranian nursing students, with major satisfaction and a sense of belonging serving as mediating factors. A cross-sectional research design was employed from April to June 2023. Undergraduate nursing students (n = 386) filled out a five-part questionnaire namely demographic and educational information, bullying behaviors in nursing education environments, the Belongingness scale, intention to drop out, and academic major satisfaction scale. The study confirmed that experiences of bullying positively correlated with intentions to drop out, negatively affected students' sense of belonging and major satisfaction, and established that course satisfaction and a sense of belonging acted as mediators between bullying and intentions to drop out. The findings show the urgent need for anti-bullying interventions targeting faculty behavior and educational strategies aimed at fostering a sense of belonging and course satisfaction among nursing students.

Nursing students' experiences of sexual harassment - A qualitative study from feminist identity perspective

AIM

To explore experiences of sexual harassment among nursing students in an East Asian region and to gain knowledge of the underlying factors influencing nursing students' conceptualization of and response to sexual harassment.

BACKGROUND

Nursing students are susceptible to sexual harassment due to gender and power inequality in healthcare systems. Sexual harassment has an adverse impact on the students' physical and mental health. Studies on sexual harassment among nursing students are limited and reported significantly varied occurrence prevalence in different cultures. Feminist identity theory can provide a framework to examine social-culturally constructed perceptions of sexual harassment.

DESIGN

A qualitative descriptive study.

METHODS

The study was conducted in Macau, a Special Administrative Region of China. Purposive sampling was applied. Twenty-six nursing students and five nursing educators participated in the study. Semi-structured interviews were conducted. Thematic analysis was used to analyze the interview data. A series of measures were applied to enhance the trustworthiness of the study.

RESULTS

While most of the students had not experienced or heard of sexual harassment, a limited number claimed sexual harassment as a frequently encountered instance. The students expressed uncertainty about what constituted sexual harassment, mainly due to a lack of exposure to information on sexual harassment. They were caught in a dilemma between exerting nursing professional virtues and exposing the misconduct of the suspected perpetrators, leading to taking passive approaches of ignoring and avoiding as the primary coping strategies. In contrast, nursing educators advocated proactive approaches as coping strategies to address sexual harassment.

CONCLUSIONS

A conflict between nursing professional identity and feminist identity is observed among nursing students. Healthcare institutions and nursing schools should develop interventions to enhance nursing students' assertiveness to sexual harassment.

Nursing students' experiences of workplace violence based on the perspective of gender differences: a phenomenological study

BACKGROUND

Workplace violence is a worldwide concern, and particularly affects nursing students. It has a seriously negative impact on nursing students' clinical learning experience and their physical and mental health. This study explored whether there are differences in psychological responses and coping styles among different gender nursing students after exposure to workplace violence, and investigated the causes for these differences.

METHODS

We enrolled 22 nursing undergraduates from Guangzhou Medical University and Zunyi Medical University, China. Phenomenological qualitative research and online semi-structured interviews were conducted. The data were analyzed by the Colaizzi seven-step content analysis method.

RESULTS

Two categories were collated: psychological experience and coping styles. Three themes of the former were extracted: negative emotional experience, low level of professional identity, and negative effect on self-efficacy. Two themes of the latter: responses to violence and adjustment after violence. In addition, fourteen subthemes were extracted.

CONCLUSIONS

Different gender nursing students have different psychological experience and coping styles in the face of workplace violence. The causes of the differences are likely related to sociocultural factors and psychological gender status.

Experience of verbal violence among Chinese nursing students in clinical practice: a qualitative study

BACKGROUND

Workplace violence is prevalent in the nursing profession, and as a relatively junior link of the professional hierarchy, nursing students are not immune to it. Among these, verbal violence may have more serious consequences for the victims than physical violence, but the literature on verbal violence among nursing students in Chinese clinical settings is limited.

AIMS

To explore the verbal violence experience among Chinese nursing students in clinical practice, and the strategies used by nursing students to cope with violence.

DESIGN

A descriptive qualitative study.

METHODS

From January 2022 to June 2022, semi-structured interviews were conducted with 21 nursing students in clinical practice by purposive snowball sampling. Nvivo12 software and inductive content analysis were used for data analysis. This paper followed the COREQ (Consolidated criteria for Reporting Qualitative Research) guidance.

RESULTS

Through data analysis, three themes were defined:(1) Multiform verbal violence; (2) Hurting and impacting and (3) Struggling or Coping. The findings indicated that nursing students were subjected to multiple forms of verbal violence in clinical practice, not only from patients and caregivers, but also from peers such as clinical tutors and doctors, which not only harmed students' personal health and well-being, but may also contribute to the nursing industry's future loss of human resources. Seeking emotional support from others and forcing themselves to grow up were the most commonly used coping strategies.

CONCLUSION

Nursing educators and nursing managers need to pay attention to verbal violence in the clinical environment, and actively develop the ability of nursing students to deal with uncivilized behavior. Establishing relevant courses and training such as communication, resilience, and violence prevention, establishing a stricter clinical mentor appointment system, and teaching assessment system may be strategies to help nursing students better perform clinical practice.

Evaluation and improvement of workplace vertical violence of nursing interns based on the Importance-Performance Analysis method

Purpose

To analyze the key factors related to workplace vertical violence among nursing interns in China and to propose strategies to improve the nursing practice environment.

Methods

A cross-sectional study was conducted using the Importance-Performance Analysis (IPA) method to analyze the key factors and significance of workplace vertical violence for nursing interns. The data were obtained by administering a workplace vertical violence survey, designed specifically for this study, to 120 nursing interns at a tertiary general hospital in Zhejiang Province, China.

Results

The results demonstrated that the variables "I was ordered to do something beyond my ability and lacked guidance (C3)," "Errors in work have been repeatedly emphasized, spread, or exaggerated (C8)," "I was unjustly criticized (C9)," "I was withheld or blocked information purposefully (C1)," and "I was belittled at work (C2)" were the most crucial variables for determining the presence of workplace vertical violence of nursing interns. Moreover, they are priority improvement variables.

Conclusion

Managers must prioritize the use of relevant resources during internships to minimize false reinforcement and unfair criticism. Efforts should focus on improving information sharing, emphasizing the role of nursing interns in clinical work, providing better guidance when arranging for nursing interns to do work that exceeds their capacity, reducing workplace vertical violence, and improving nursing intern practice environments.

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.

Assessing the quality of nursing clinical placement: A quantitative cross-sectional study

AIM

To evaluate the quality of nursing clinical placement among nursing students.

DESIGN

This is a descriptive cross-sectional study.

METHODS

Two hundred eighty two nursing student completed self-administered, online questionnaires. The questionnaire assessed participants' socio-demographic data, and the quality of their clinical placement.

RESULTS

The students had a high mean score for the overall satisfaction of their clinical training placement with high mean score for the item of "patient safety was fundamental to the work of the units" and the item of "I anticipate being able to apply my learning from this placement," while the lowest mean score was related to "This placement was a good learning environment" and "Staff were willing to work with students." Patient or Public Contribution: Quality of clinical placement is critical for improving the everyday quality of care for patients who are in desperate need of caregivers with professional knowledge and skills.

Nursing students' experiences of unprofessional behaviours and associations with guideline compliance: A multicenter survey

AIMS

To assess the reported prevalence of unprofessional behaviours, including incivility and bullying, experienced by nursing students during their clinical practice. To assess the prevalence of students' abilities to speak up about unprofessional behaviours encountered and infection control concerns; their compliance with standard precautions and COVID-19 guidelines; and their perceived responsibility for infection prevention. Lastly, to describe the potential impact of unprofessional behaviour on compliance with these guidelines.

BACKGROUND

Unprofessional behaviours in healthcare settings are associated with a wide range of individual and organisational negative outcomes for nurses and nursing students, which may affect patient safety. The COVID-19 pandemic created new challenges for clinical education and for infection control.

DESIGN

A descriptive cross-sectional design.

METHODS

A multi-centre survey was carried out in six academic universities and colleges in Israel. The research study involved 369 undergraduate nursing students during 2022. Their clinical experiences were assessed using an online questionnaire. The STROBE guideline was used for accurate reporting.

RESULTS

301 (81.6%) students reported experience of unprofessional behaviour while undertaking clinical practice. Students with reported skills to speak up about unprofessional behaviour were less likely to report having experienced these behaviours (p = 0.003). Students who did not experience unprofessional behaviours were more likely to report higher compliance with standard and COVID-19 precaution guidelines (OR 3.624, 95% CI 1.790-7.335, p < 0.001). These students also had a higher perception of personal responsibility toward patient safety (OR 1.757, 95% CI 1.215-2.541, p = 0.003).

CONCLUSIONS

Nursing students experiencing unprofessional behaviours in the clinical setting reported lower compliance with standard and COVID-19 precautions. In addition, cultivating personal responsibility towards patients' safety may have a positive impact on guidelines compliance. Nursing educators and leaders should develop strategies to enable students to better cope with unprofessional behaviours. Closer cooperation between all stakeholders may promote civility among nurses and nursing students in the clinical setting.

Student nurses' experiences of workplace violence: A mixed methods systematic review and meta-analysis

OBJECTIVES

To identify the prevalence of student-directed violence on clinical placement and description of their related experience during clinical placements.

DESIGN

Mixed methods systematic review and meta-analysis conducted following Joanna Briggs Institute guidelines and reported according to Preferred Reporting of Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

DATA SOURCES

CINAHL, Embase, Medline, Proquest, PsycINFO and Google Scholar.

REVIEW METHODS

Included studies were peer reviewed, published primary studies where pre-registration nursing students were surveyed about their experiences of physical, verbal, or sexual aggression, bullying or racism during clinical placement. Studies were quality assessed but not excluded based on the result. A convergent segregated approach to synthesis and integration was undertaken. Prevalence data were extracted and pooled using both random and quality effects models; separate analyses were conducted by violence type, source, and region. Qualitative data were thematically analysed.

RESULTS

14,894 student nurses from 42 studies were included across the meta-analyses. There was substantial heterogeneity in the included data. Pooled prevalence rates ranged from racism 12.2 % to bullying 58.2 %. Bullying (38.8 %) and physical aggression (10.2 %) were most perpetrated by nurses whereas sexual aggression was perpetrated mostly by patients (64.2 %) and physicians (18.6 %). Qualitative findings identified students' descriptions of reasons for, effects of, strategies for dealing with and higher education establishments' responsibilities with regards to workplace violence.

CONCLUSIONS

Student nurses commonly experience violence during their clinical placements. Given the potential debilitating physical and psychological sequelae of all forms of violence then this study further emphasises the need to use multiple strategies to prevent violence and to better equip student nurses to manage potentially violent incidents, their responses to violence, and to whistle blow or report when they are subject to violence.

Factors leading to disruptive behaviours at central hospitals in Harare Metropolitan Province: Radiography managers perspectives

BACKGROUND

The negative consequences of disruptive behaviours involving healthcare workers threatens the institution's image, staff morale, finances, and patient safety. While all kinds of health organisations or settings are potentially exposed to disruptive behaviours, some are at higher risk than others because of both environmental and cultural factors. Such risk should be assessed having regard to the specific situation and conditions in which each healthcare organization operates.

AIM

The aim of this study was to explore radiography manager's perspectives on the environmental and cultural factors leading to DBs involving radiographers at central hospitals in Harare Metropolitan Province.

METHODS

An exploratory qualitative study employing in-depth interviews with 11 radiography managers across five departments at three central hospitals selected by criterion purposive sampling was done. The interview data were analysed using Tesch's method of qualitative analysis.

RESULTS

The key environmental and cultural factors identified included three themes: power hierarchy, work environment and reporting framework. Power hierarchy comprised categories, superiority, professional boundaries and representation. The work environment incorporated categories, trust in leadership, burnout and fatigue and remuneration. Lastly, reporting framework included categories, lack of protocol and reporting culture.

CONCLUSION

Radiography managers believe that environmental factors play a bigger role in leading to disruptive behaviours that involve radiographers at central hospitals in Harare Metropolitan Province. This underscores the need for hospital and radiography managers to pay particular emphasis on these when formulating policies and procedures to address these behaviours. Addressing DBs ensures that healthy work environments are promoted which in turn ensures that patients receive optimum and safe care.

IMPLICATIONS FOR PRACTICE

The paper provides an insight into the environmental and cultural dynamics that may trigger disruptive behaviours involving radiographers. This information is invaluable in formulating policies and procedures for addressing these unprofessional behaviours.

Expectations of learner nurses in sampled clinical areas of the Limpopo province, South Africa

BACKGROUND

Nurse training in South Africa requires placing learner nurses in real-life setting for them to gain practical experience. To complete their training and be competent practitioners, learner nurses must have expectations and aspirations when they go for practice.

AIM

This study sought to understand learner nurses' expectations at clinical learning areas during placement.

SETTING

Four clinical learning areas in the Limpopo province were purposely sampled. Tertiary, regional and district hospitals were sampled to obtain information from different levels of care.

METHODS

A qualitative, descriptive and contextual design was used to explore the expectations of learner nurses during clinical placements. Permission to conduct the study was obtained from various bodies and ethical considerations were ensured. Nonprobability purposive sampling was used, and six focus groups were formed. Each focus group discussion (FGD) had six to eight participants. The FGDs were according to level of study, with the third and fourth levels each having two FGDs because of the number of participants.

RESULTS

The following three themes emerged: milieu in the clinical learning areas, learning in the clinical areas and self-actualisation.

CONCLUSION

The clinical learning areas are institutions of promoting learning through practice. They should promote learning and offer support to learners so that learners meet their expectations, which may prevent discouragement and attrition.

CONTRIBUTION

This study adds to the body of knowledge in nursing education and practice because when students' expectations are met, their training outcome might be positive leading to competent professional nurses.

Incivility in practice - incidence and experiences of nursing students in eastern Canada: A descriptive quantitative study

BACKGROUND

Incivility within nursing is professionally unacceptable. Little research exists regarding student nurses' experiences with incivility from healthcare professionals and others within the clinical environment and particularly within a Canadian context.

AIM

To describe the incidence and perceptions of incivility experienced by undergraduate nursing students from healthcare professionals and others within clinical practice.

METHOD

This descriptive study used an electronic survey and was conducted at an eastern Canadian university. Descriptive statistics were applied.

RESULTS

Of 650 nursing students invited to participate in the study, 260 surveys were fully completed. Of these, 70% of respondents indicated experiencing incivility, mostly in acute care settings. Registered nurses and licensed practical nurses were the major offenders. Discourteous gestures and condescending remarks were the most frequently experienced uncivil acts, resulting in feelings of high anxiety and inadequacy. Participants coped by avoiding communication with the perpetrator. Incivility was rarely reported because of a belief it would be fruitless to do so, lack of awareness of policies and fear of retaliation.

CONCLUSIONS

Nursing students experience incivility frequently in clinical practice with serious consequences. Recommendations arising from this study encourage educators and healthcare leaders to collaborate to review, implement and evaluate curricula, policies and processes to address incivility.

Facilitators of professional socialisation of learners in the clinical learning areas: A qualitative systematic review

Background

Professional socialisation is significant in nursing as it involves immersing learners in the profession so that they adopt the ethical values and conduct of the profession. It is in the clinical learning areas where learners observe and practise those values. The objective of the review was to explore the factors that promote professional socialisation of learners in the clinical learning areas. The problem is the inadequate support for learner nurses in the clinical learning areas. The South African community has lost trust in nurses and that was even acknowledged in the national nursing summit in 2011.

Objectives

To present a review of the factors that facilitate professional socialisation among undergraduate nursing learners.

Method

A systematic review was conducted on literature from 2008 to 2018. The literature search focused on factors that facilitate professional socialisation of learner nurses. A search of databases was conducted in CINAHL, MEDLINE, Google Scholar and Science Direct. The search focused on literature on professional socialisation of learner nurses published from 2008 to 2018. The search resulted in 3035 articles which were further reduced to 13 after further synthesis. Critical appraisal skills programme was used to assess the quality of the studies.

Results

Three main themes emerged. Learner factors, factors in the clinical learning areas and interpersonal factors were identified as the factors that facilitate professional socialisation of learners.

Conclusion

Learners should have self-motivation and be supported and assisted to develop a positive professional identity. The clinical learning environment should have effective communication that fosters learning. Professional nurses should act as exemplary role models so that learners can emulate the conduct and practice. The review brought to light that the professional socialisation of learners is affected by the learner factors, clinical learning areas and personal factors.

Student perspectives of extended clinical placements in optometry: a qualitative study

BACKGROUND

The number of students enrolled in health courses at Australian universities is rising, increasing demand for clinical placements. Optometry students have historically undertaken clinical training in short-block rotations at university-led teaching clinics in metropolitan locations. This is changing, with some optometry programs adopting extended placements. These placements are conducted in community-based practices, with many incorporating a rural component to the training. This study explored factors which influence placement success and satisfaction from the perspective of optometry students.

METHODS

Nine focus groups were undertaken with 42 final year optometry students upon completion of a 26-week placement (of which at least half was undertaken in a non-metropolitan area, or area where a shortage of optometrists has been identified). Focus groups were audio recorded and transcribed verbatim. Thematic analysis was conducted according to Braun and Clarke's 6 step method.

RESULTS

Four key themes were identified during analysis. 'Changing identity', related to how the students grew both personally and professionally, with the extended placement being considered the vital component that allowed students to begin thinking of themselves as clinicians. The theme 'Dealing with complex dynamics and circumstances' predominantly described instances where the student-supervisor relationship was strained, resulting in high levels of anxiety made worse by a perceived lack of university support. 'Optometrist under instruction', related to students feeling that the placement was an ideal opportunity to trial the everyday reality of work without the obligation of an ongoing commitment or employment contract. Finally, the theme 'Rural practice is more rewarding', was about a chance to seek different experiences, meet new people and challenge themselves professionally.

CONCLUSION

While the majority of students enjoyed their placement and felt that it was the key component of their training that equipped them for future practice, it is clear that universities and placement providers must provide both students and supervisors thorough and explicit guidance covering placement expectations. Furthermore, student support systems should be embedded into placement programs to ensure where issues arise, they are dealt with promptly and successfully. It is vital that ongoing professional development and pedagogical training for supervisors underpins continued accreditation.

Bullying in the clinical setting: Lived experiences of nursing students in the Central Region of Ghana

INTRODUCTION

Nursing students are confronted with bullies in the classroom and during clinical placement. Acquisition of the necessary psychomotor skills intended during clinical placements may be impeded when workplace bullies intimidate students. This study aimed to describe the various bullying behaviours experienced by nursing students and their effects during clinical placement in the Central Region of Ghana.

METHODS

A qualitative phenomenological descriptive approach using a semi-structured interview guide was employed to collect data from nursing students in focus groups. Overall, six (6) focus groups were used, with five (5) students in each group comprising males and females. The sample size was based on data saturation and was saturated on the six focus group discussions giving a sample size of 30. Purposive sampling was used to select students who had been on the ward at least three clinical placements and had experienced bullying in the clinical setting. In-depth interviews were conducted, recorded, transcribed verbatim and analysed using content analysis.

RESULTS

The study revealed that nursing students had experienced bullying practices such as shouting, isolation, humiliation and being assigned tasks below their competency level. In addition, findings showed that bullying led to a loss of confidence and caused stress and anxiety in nursing students.

CONCLUSION

Therefore, it is recommended that nursing students are mentored holistically in a caring and accepting environment where they will be supported to achieve their learning goals, build their confidence, and develop their personal and professional identity.

Bullying in nursing students: A integrative literature review

The purpose of this integrative review was to analyse the current situation of bullying in nursing students through an exhaustive review of the last 10 years. As the sources of information, we used electronic databases, such as Medline, CINAHL, PubMed, Cochrane, and SciELO, using bullying, nursing students, and clinical environment as search terms. We based the methodology of the study in PRISMA checklist. Articles were selected for their relevance and suitability for the purpose, and they were constructed into a table. A critical appraisal was done using MMAT TOOL and AACOODS checklist. Papers were analysed using a constant comparison and a concept mapping. Finally, 30 articles were included. We analysed: prevalence, profile of the victim and perpetrator, type of violence, and bullying consequences. Bullying prevalence varied from 9-96% according to the author. Differences about the influence of sociodemographic variables were detected, there is no consensus about age, gender, or educational level. Bullying in nursing students is an important problem that affects all spheres of their life. Harassment also has consequences for the patient and for the health organization, so it is really important to take action regarding bullying and to act to victims, perpetrators, and health organizations. Regarding to implications for nursing practice, we found that some interventions were useful to reduce bullying, so it is important to participate in intervention programmes to eventually stop this problem. This study has revealed that more research on the efficacy of psychological intervention programmes to help students cope with bullying situations is essential.

Prevalence of incivility between ophthalmology and emergency medicine residents during interdepartmental consultations

OBJECTIVES

Since incivility is linked to adverse effects in patient care and health care worker well-being, evaluation of the prevalence of incivility during the formative years of residency training is warranted. The aim of this study was to determine the perceived presence and degree of incivility between emergency medicine (EM) and ophthalmology residents during emergency department (ED) consultations.

METHODS

We conducted a single-site, survey-based study, targeted to ophthalmology and EM residents. The survey we distributed included questions adapted from validated and widely used surveys measuring incivility in the workplace (Workplace Incivility Scale) and incivility within the ED.

RESULTS

Ophthalmology (13/15, 86.7%) and EM (42/48, 87.5%) residents participated, with an overall response rate of 55 of 63 (87.3%). Most residents (47/55, 85.5%) reported some degree of incivility during consultations, with a greater proportion of females reporting incivility (100%) than males (77.4%, p = 0.033). A total of 52.7% of respondents reported occurrence of incivility on a quarterly basis; 21.8% reported monthly, 10.9% weekly, and none daily. Incivilities were reported most commonly during nonurgent consults (85.5%). The two most common incivilities reported by trainees were when the other party paid little attention to their statements or opinions (80% of residents) or doubted their professional judgment (74.5% of residents). More female trainees reported jokes being told at their expense compared to males (15.8% vs. 0%, p = 0.049). Residents most often attributed incivility to stress (78.2%), loss of empathy/burnout (63.6%), or attempts to shift responsibility to another party (60.0%). Among EM residents surveyed, incivility was identified as occurring most often during consultations with surgical specialties.

CONCLUSIONS

Incivility during interdepartmental consultations between EM and ophthalmology is commonly reported by physicians-in-training. It occurs more often during consultations deemed as nonurgent and is more commonly reported by females. Given its associations with adverse outcomes, interventions to decrease incivility early in training may be warranted.

Nursing degree students' clinical placement experiences in Australia: A survey design

AIM

This study aimed to evaluate Australian nursing students' views of placements at seven tertiary education institutions with the use of the Placement Evaluation Tool (PET).

BACKGROUND

Clinical placements are a core element of healthcare education programs around the world (Chuan and Barnett, 2012) with undergraduate nursing students required to complete a prescribed number of hours as part of their degree. The quality of nursing clinical placements varies with a range of positive and negative learning experiences.

DESIGN

A survey design was used with a contemporary survey tool- the Placement Evaluation Tool (PET). Using Qualtrics software (Qualtrics, 2005) the on-line survey was distributed to approximately 6265 undergraduate nursing students at six Australian universities and one Technical and Further Education (TAFE) college where Bachelor of Nursing degree students were enrolled. Three Australian States were covered. Sites were selected where a project team member was employed.

METHODS

A total of 1263 nursing students completed the Placement Evaluation Tool (PET) - 19 items (rated 1-5), one global rating (rated 1-10) - following placement in three Australian States (July 2019-February 2020). Most - 618 (48.9%) completed a placement in acute care with placements positively rated overall.

RESULTS

The total PET mean score was 78.3% with 29.8% being 'extremely satisfied' (10 out of 10 - Item 20). However, 11.0% were dissatisfied with global ratings of four or less, whilst ratings between States differed significantly (p = <0.001). One third of respondents answered a free text statement relating to placement experiences, with significantly more comments from older students (p = <0.001) and from those with ratings in the lower range (p = <0.001). Three core themes emerged: 1. Staff Attitudes to Students, 2. Environment and 3. Lifestyle.

CONCLUSIONS

Whilst students' clinical experiences in Australia tend to be positive a minority reported exposure to negative staff attitudes, in unsafe environments, with lifestyle detriments. Further work is required to understand and enhance student experiences.

Peer-mentees' challenges in an undergraduate peer-group clinical mentoring programme in a nursing education institution

Background

Clinical competency and professional growth amongst nursing students is the cornerstone of a nursing education programme. The demanding and complex training of nursing students requires various clinical teaching and learning strategies such as peer-group clinical mentoring.

Aim

The objective of this research was to explore and describe the challenges that peer-mentees experience in an undergraduate peer-group clinical mentoring programme in one-specific nursing education institution in the North West Province.

Setting

The study was conducted at a nursing education institution in North West Province.

Methods

A qualitative, retrospective case study research design was used. Two separate World Café sessions following a semi-structured schedule based on Gibbs Reflective Cycle were conducted with 51 peer-mentees who were mentored in clinical practice. Four levels of qualitative thematic data analyses were employed to analyse the data.

Results

Five themes emerged from the findings of the study, namely, poor implementation of the peer-group clinical mentoring programme, ineffective undergraduate peer-group clinical mentoring programme, undesirable attitudes of the mentors, mentors unprofessional conduct as well as communication challenges. Ten sub-themes emerged from the findings. Literature control was done to support the findings.

Conclusion

The findings showed that undergraduate nursing students faced a diversity of challenges in the effective learning and teaching of peer-mentees in a clinical context. Limitations and recommendations of the study were given. Recommendations were given for nursing practice, education and research.

Effect of Korean nursing students' experience of incivility in clinical settings on critical thinking

Clinical experience is essential to helping nursing students to achieve and practice professional knowledge and skills. Published reports indicate nursing students often experience incivility during clinical practice. The purpose of this study was to investigate nursing student incivility experience during their clinical rotations and the relationship of these experiences with their critical thinking dispositions. A cross-sectional descriptive correlational study design was utilized. Data were collected from junior (n = 195) and senior (n = 180) students in a Bachelor of Science in Nursing (BSN) program in Seoul, Korea between October 15, 2017 and November 20, 2017 using a self-administered survey. Three instruments were used in the survey: six sociodemographic questions, the 13-item Korean version of Uncivil Behavior in Clinical Nursing Education (K-UBCNE) and the 27-item Yoon Critical Thinking Disposition (YCTD) tool. Data analysis revealed junior students reported significantly more incivility from nurses than the senior students (p = .038) during clinical learning experiences. Among YCTD subscales, the Prudence (p = .007) and Self-Confidence critical thinking (p = .007) scores from the senior nursing students were significantly higher than the junior students' scores. No significant relationship was found between experience of incivility and critical thinking disposition scores. Based on the study results, nursing educators, staff nurses, and administrators/managers in nursing should identify incivility toward nursing students during clinical practicums and especially toward junior nursing students. Additional investigation of the relationship between critical thinking and experiences of incivility is warranted, including longitudinal investigations and qualitative studies among junior nursing students to understand their personal experience of incivility in the clinical setting. Findings could inform the development of targeted programs to reduce clinical incivility.

Predictors and triggers of incivility within healthcare teams: a systematic review of the literature

OBJECTIVES

To explore predictors and triggers of incivility in medical teams, defined as behaviours that violate norms of respect but whose intent to harm is ambiguous.

DESIGN

Systematic literature review of quantitative and qualitative empirical studies.

DATA SOURCES

Database searches according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline in Medline, CINHAL, PsychInfo, Web of Science and Embase up to January 2020.

ELIGIBILITY CRITERIA

Original empirical quantitative and qualitative studies focusing on predictors and triggers of incivilities in hospital healthcare teams, excluding psychiatric care.

DATA EXTRACTION AND SYNTHESIS

Of the 1397 publications screened, 53 were included (44 quantitative and 9 qualitative studies); publication date ranged from 2002 to January 2020.

RESULTS

Based on the Medical Education Research Study Quality Instrument (MERSQI) scores, the quality of the quantitative studies were relatively low overall (mean MERSQI score of 9.93), but quality of studies increased with publication year (r=0.52; p<0.001). Initiators of incivility were consistently described as having a difficult personality, yet few studies investigated their other characteristics and motivations. Results were mostly inconsistent regarding individual characteristics of targets of incivilities (eg, age, gender, ethnicity), but less experienced healthcare professionals were more exposed to incivility. In most studies, participants reported experiencing incivilities mainly within their own professional discipline (eg, nurse to nurse) rather than across disciplines (eg, physician to nurse). Evidence of specific medical specialties particularly affected by incivility was poor, with surgery as one of the most cited uncivil specialties. Finally, situational and cultural predictors of higher incivility levels included high workload, communication or coordination issues, patient safety concerns, lack of support and poor leadership.

CONCLUSIONS

Although a wide range of predictors and triggers of incivilities are reported in the literature, identifying characteristics of initiators and the targets of incivilities yielded inconsistent results. The use of diverse and high-quality methods is needed to explore the dynamic nature of situational and cultural triggers of incivility.