Nurses and undergraduate student nurses' experiences in collaborative clinical placement programs in acute hospitals: An integrative literature review

Defining sense of belonging in nursing - An evolutionary concept analysis

OBJECTIVES

The purpose of this analysis is to develop the concept of sense of belonging in nursing. The secondary purpose is to identify the antithesis or direct opposite beyond the negative consequences related to a lack of belonging in nursing.

DESIGN

Rodgers' evolutionary method guided the analysis and advancement of sense of belonging in nursing.

DATA SOURCES

Following PRISMA guidelines, peer-reviewed English articles and dissertations were reviewed from PubMed, ERIC, CINAHL, and PsychINFO. Forty-seven articles describing sense of belonging in the nursing profession, both academic and workforce, were included.

REVIEW METHODS

Inductive thematic analysis was used to determine recurring themes of the antecedents, attributes, consequences, and antithesis of belonging in nursing.

RESULTS

A welcoming, positive atmosphere encouraging a culture of mentorship is key to developing an environment of belonging. The attributes of belonging include being trusted, valued, and an accepted part of the team, and encouraging a connection to the community. Nurses and nursing students have improved confidence, self-esteem, and motivation to learn when a sense of belonging is present. They feel supported and respected in the environment. However, historically minoritized students and nurses report discrimination, bias, and condescension resulting in feeling invisible, isolated, excluded, and neglected. Nurses and nursing students feel invisible, isolated, excluded, and neglected without a sense of belonging.

CONCLUSION

Developing a sense of belonging in nurses and nursing students is critical to our profession. Further research is essential to develop interventions and strategies for cultivating a sense of belonging in nursing.

Nurses, midwives and students' reports of effective dedicated education units in five European countries: A qualitative study

AIM

To investigate nursing/midwifery students, Clinical Mentors, Link Teachers and Head Nurses experiences within "Dedicated Education Unit" model in 6 European clinical placements and analyse the necessary elements for a powerful clinical learning environment.

DESIGN

A multi-country, phenomenological, qualitative study.

METHODS

Focus group interviews were performed to identify the personal and organizational factors of importance for students and nurses/midwives.

RESULTS

Data analysis produced 4 main themes (1) Clinical placement organization, (2) students' clinical knowledge and skill acquisition, (3) students, and nurses/midwives' experiences within the DEU model and (4) factors for creating an effective learning environment.

CONCLUSIONS

A close educational-service collaboration, a realistic clinical placement planning, a focus on student learning process and an investment in professionals' education and development among others, are elements to set up a powerful clinical learning environment.

IMPLICATIONS FOR THE PROFESSION

It is considered advisable and urgent to improve the working conditions of nurses/midwives and the learning environments of students as a strategy to alleviate the global shortage of nurses and respond to the increasingly demanding health needs of the population.

IMPACT

Due to the close relationship between students' learning and features of the clinical environment nurse educators seek innovative models which allow students to manage patient care and their transition to professional practice. To implement new learning strategies, identifying students, nurses and midwives perceptions and suggestions is a powerful information to evaluate implementation process and outcomes.

PUBLIC CONTRIBUTION

Our findings could help academic and clinical managers to meet the human and organizational requirements to create a successful learning environment in every student placement.

Exploring the sociocultural experiences of student veterinary nurses in the clinical learning environment through the lens of situated learning theory

BACKGROUND

Student veterinary nurses (SVNs) complete significant time in clinical placements and this training can have a positive or negative impact on the development of professional skills and identity.

METHODS

A cross-sectional design, using semi-structured interviews, explored 12 SVNs' experiences of clinical placements. Interpretative phenomenological analysis was used to explore each individual participant's experience, prior to the identification of themes across participants' experiences.

RESULTS

Most students reported a sense of belonging within the practice team, which fostered engagement. Clinical supervisors were considered key role models and vital support for student progress. Students reported conflict between the demands of the practice and the requirements of their student status. Some poor interpersonal interactions led to reduced confidence.

LIMITATIONS

The results may not reflect experiences of the diversity of student demographics, such as those students with protected characteristics, as described in the Equality Act 2010, who may encounter specific workplace challenges.

CONCLUSION

To ensure parity and positive experiences, accredited educational institutes can plan regular engagement with student feedback and support of the training practice. Training practice teams can ensure they are meeting the student's needs and fostering a positive learning environment by adhering to the RCVS Framework for Veterinary Nurse Education and Training, which will, in turn, benefit the whole team. Clinical supervisors can play a convening role in increasing belonging and participation within the clinical learning environment.

Modifiable factors contributing to belongingness of undergraduate nursing students in the clinical learning environment: An exploratory study

BACKGROUND

Belongingness has been tied to positive personal and educational outcomes in undergraduate nursing students in the clinical learning environment, but there is limited literature on specific factors that promote these important feelings of acceptance and value alignment.

OBJECTIVES

This study aimed to assess demographic characteristics, program/clinical structure factors, and modifiable clinical setting factors that may impact feelings of belongingness in U.S. undergraduate nursing students in the clinical learning environment.

DESIGN

A cross-sectional survey design was used to assess the relationship between demographics, program/clinical structure factors, and modifiable clinical setting factors and levels of belongingness using the U.S. version of the Belongingness Scale - Clinical Placement Experience.

SETTING

A national study was conducted via the National Student Nurses Association database from December 2022 to January 2023.

PARTICIPANTS

759 volunteer undergraduate nursing students in the U.S. who had completed at least one clinical course.

METHODS

An online survey was disseminated to assess demographic factors, program/clinical structure factors, students' perceptions on the frequency of occurrence and perceived value of modifiable clinical setting factors (including clinical format, clinical site, relationship and interpersonal, and miscellaneous factors), and to measure levels of belongingness experienced.

RESULTS

Bivariate analyses revealed one statistically significant program/clinical structure factor (p <.001) and 10 statistically significant modifiable clinical setting factors (p <.001) that contribute to belongingness. The findings also support the use of the U.S. version of the BES-CPE as a reliable and valid instrument.

CONCLUSIONS

Results demonstrate the importance of fostering belongingness in undergraduate nursing students in the clinical learning environment and, for the first time, extrapolate qualitative findings from the literature into the identification of factors that contribute to these critical feelings of inclusion. There are immediate implications for nursing educators and a rich foundation for future intervention research is proposed.

Veterinary Nursing Students' Experience in the Clinical Learning Environment and Factors Affecting their Perception

Student veterinary nurses (SVNs) spend a significant proportion of their training time within the clinical learning environment (CLE) of a veterinary practice. These clinical experiences are vital for building practical and professional skills. To evaluate the current satisfaction of SVNs in the CLE, a cross-sectional survey design was used incorporating a previously validated instrument. To provide understanding of factors that may affect the SVN satisfaction, additional validated tools were added across factors, including resilience, wellbeing, personality, and work place belonging. A total of 171 SVNs completed the survey. In addition, two open questions were included to provide greater depth of understanding of the SVN experiences. Results showed that 70.76% of respondents were satisfied/very satisfied with the CLE. Significant factors that affected the satisfaction scores included, depression, anxiety, and stress (p ≤ .001), psychological sense of organizational membership (p ≤ .001), agreeableness (p = .022), and emotional stability (p = .012). The qualitative data demonstrated shared SVN factors that are considered to contribute to clinical learning and those that detract from clinical learning. Educational facilities and training veterinary practices can support the SVN within the CLE by creating a greater sense of belonging, considering the SVN individual personality and wellbeing, and including the SVN in discussions around learning support needs.

Collaborative clinical facilitation in selected nursing and midwifery colleges in Northern Ghana

Background

Collaborative clinical facilitation converges key players to guide students individually and within groups towards achieving clinical nursing competence. However, experiences of collaborative clinical facilitation among nurse educators, clinical preceptors and nursing and midwifery students are often fragmented and have been largely unexplored in Ghana.

Aim

To describe the experiences of collaborative clinical facilitation among nurse educators, clinical preceptors and final year nursing and midwifery students in Northern Ghana.

Setting

The study was conducted at two nursing and midwifery colleges and an academic hospital in Northern Ghana.

Methods

A qualitative, descriptive, exploratory design was utilized. Forty-six participants comprising 16 nurse educators, 10 clinical preceptors, 10 nursing students and 10 midwifery students were purposively sampled. Focus groups and in-depth interviews were used to gather data and analysed thematically.

Results

Three themes revealed facilitative experiences of collaborative clinical facilitation: team-based clinical mentorship and supervision, personalised preceptorship, and clinical conferences. Two themes emerged inhibitory to collaborative clinical facilitation: staff shortages and lack of timely communication.

Conclusion

This study found that team mentorship, preceptorship and conferences fostered collaborative clinical partnerships for students' clinical learning. However, failure to engage in timeous communication in the midst of staff shortages hampered its smooth practice. Orientation workshops need to be organised for key players to share relevant updates and explore ways to navigate the challenges often experienced within the clinical training environment.

Contribution

This paper provides insight into the collaborative nature of clinical facilitation; and highlights the need for coordinated clinical placements to enhance students' clinical learning.

Developing the SVN CLEI: A Novel Psychometric Instrument for Evaluating the Clinical Learning Environment of Student Veterinary Nurses in the UK

Student veterinary nurses (SVNs) in the United Kingdom can spend over half their training time within the clinical learning environment (CLE) of a training veterinary practice before achieving clinical competency. Sociocultural complexities and poor management within the CLE may have a significant impact on the learning experiences of SVNs, as has been found in studies involving student human nurses. The aim of this research was to develop and validate the SVN CLE Inventory (CLEI) using principal component analysis (PCA), via a cross-sectional design, based on inventories already established in human nursing CLEs. The SVN CLEI was distributed to SVNs via an online survey over a 3-month period, generating 271 responses. PCA resulted in a valid and reliable SVN CLEI with 25 items across three factors with a total variance explained of 61.004% and an overall Cronbach's alpha (α) of .953 (factor 1: clinical supervisor support of learning [α = .935]; factor 2: pedagogical atmosphere of the practice [α = .924]; factor 3: opportunities for engagement [α = .698]). Gaining student feedback is a requirement set out by the Royal College of Veterinary Surgeons Standards Framework for Student Veterinary Nurse Education and Training, and the SVN CLEI can be used to complement the current evaluation of the training veterinary practice CLE. This will facilitate development of a more comparable, consistent, and positive experience for SVNs during clinical training in the UK.

Experiences of registered nurses supporting nursing students during clinical placement using a facility-based model: A mixed methods study

BACKGROUND

An ageing workforce and increased vacancies has seen a steady growth in nursing student enrolments. This has created a need to re-think how to optimise existing clinical placement opportunities while ensuring quality student experiences and staff satisfaction in their support role.

OBJECTIVES

To provide insights into the experiences and satisfaction levels of Registered Nurses who supported nursing students during clinical placement using a facility-based model.

DESIGN

A quasi-experimental design.

SETTINGS

Three wards in an acute care facility and Primary and Community Health within the Southwest of Sydney, New South Wales, Australia.

PARTICIPANTS

Participants included Registered Nurses/Midwives, Facility-based liaison support staff, and Nurse Managers.

INTERVENTION

Within the 24/7 facility-based model, each nursing student was allocated to one Registered Nurse for the duration of the clinical placement period. The pair was rostered to complete the same day, evening, night, and weekend shifts.

METHODS

A cross-sectional survey related to staff satisfaction was administered to participants at two time points: (a) prior to the commencement of the intervention (baseline survey); and (b) at the completion of the intervention. Following the intervention participants were invited to a focus group or an individual interview.

RESULTS

There were no statistically significant changes in the levels of staff satisfaction from baseline to post-intervention; with personal fulfilment scoring the highest and workload the lowest. Staff who worked in the Primary and Community Health settings were less satisfied with this model of student support. Overall, most participants reported high personal satisfaction, professional growth and development opportunities yet acknowledged this came at a cost, with an increased workload.

CONCLUSIONS

Participants were satisfied with the facility-based model in supporting student learning on clinical placement. The model is fit for purpose however it does need to be tailored to the contextual needs of nurses working in Primary and Community settings.

‘A much kinder introduction’: exploring the benefits and challenges of paediatric simulation as a transitioning tool prior to clinical practice

Simulated practice is an opportunity to transition nursing students from on-campus learning to clinical practice. There is limited evidence on simulated practice’s role in assisting this transition at the beginning of a nursing student’s education in terms of benefits, challenges, differences and affordances. This study aimed to research the impact of a simulated practice programme as a transitioning tool for first-year paediatric nursing students.

A participatory action research approach was used to address challenges in student’s transitioning to clinical practice and a lack of clinical placement capacity. A low-technological (physical), high-authenticity (emotional and environmental)-simulated practice programme for first-year paediatric nursing students was implemented. Forty students across two cohorts were recruited, and a qualitative survey was completed post-simulation/pre-clinical practice and post-clinical practice. Reflexive thematic analysis was used to develop the resulting themes.

There was an initial 93% response rate after the simulated practice and 88% after clinical placement. Eight themes (‘bridging’ from simulation to practice and to enhance practice; ‘preparedness’ once on clinical placement; ‘applied learning’ reliably transferred to practice; ‘skill decay’ between simulation and practice; ‘same but different experiences’ between simulation and practice; simulation and clinical ‘practice pace’; ‘safety’ of simulation; and ‘unique affordances’ of simulated practice) were constructed from the data, and an additional nine sub-themes were identified (transference to practice; practice enhancement; slow-motion care; hectic; it is safe; it was safe; feedback and reassurance; practice and practice; and unpressured). Collectively, the themes indicated that simulated practice in this context is conveyed as a well-being tool in addition to having experiential learning and bridging benefits.

This study revealed that simulated practice can assist in transitioning paediatric student nurses to clinical practice. It identified its value in terms of fostering holistic learning, well-being and bridging theory to practice. To ensure long-term effectiveness, simulation maintenance training, booster training and refresher strategies should be included as part of the programme to prevent skill decay. Future studies should consider isolating these key findings for a more in-depth look at their meaning.

The contribution of paid employment for students during their pre-registration nursing studies: An integrative review

OBJECTIVE

This integrative review of the literature explores potential associations between paid employment during students' pre-registration study period and development of workplace capabilities. The capacity to demonstrate attainment of standards of practice upon registration as a nurse is essential for the delivery of safe, quality care. The increasing shift, internationally, to higher education, concerns have been raised about limited time in practice settings and consequently nurses' capability upon employment. Extensive research has been conducted into student clinical placement models and graduates transition programs, but employment during students' pre-registration study has received little consideration.

DESIGN

An integrative approach of peer reviewed articles.

DATA SOURCES

A systematic search of the literature published between 1996 and 2021 across five electronic data bases; including Cumulative Index to Nursing and Allied Health Literature, Scopus, Medline, American Psychological Association and Education Resource Information Centre was conducted.

REVIEW METHODS

Data was analysed according to the Whittemore and Knafl (2005) framework to maintain a methodical and meticulous approach.

RESULTS

Fourteen studies differentiated graduates employed during their studies. Employment contributed to developing capabilities across four domains, namely, personal growth and development, comprehensive nursing practice, organisational capability and professional values and behaviours upon employment.

CONCLUSION

Employment during pre-registration studies is associated with developing workplace capabilities. Opportunities to develop the capability of graduates should focus on the possibility of 'learning' during employment rather than merely a recruitment strategy.