Exploring the transition and professional socialisation from health care assistant to student nurse

The impact of prior care experience on nursing students' compassionate values and behaviours: A mixed methods study

BACKGROUND

Compassion is critical to the provision of high-quality healthcare and is foregrounded internationally as an issue of contemporary concern. Paid care experience prior to nurse training has been suggested as a potential means of improving compassion, which has been characterised by the values and behaviours of care, compassion, competence, communication, courage, and commitment. There is however a dearth of evidence to support the effectiveness of prior care experience as a means of improving compassion in nursing.

OBJECTIVE

To explore the impact of paid prior care experience on the values and behaviours of pre-registration nursing students indicated as characterising compassionate care.

DESIGN

Longitudinal mixed methods design employing a modified concurrent triangulation strategy, comprising two work packages. Work package 1 was qualitative, and work package 2 adopted a concurrent embedded strategy with a dominant quantitative component. Research is reported in accordance with the Good Reporting of a Mixed Methods Study framework.

SETTING(S)

Three United Kingdom universities.

PARTICIPANTS

Pre-registration nursing students attending one of three universities, and individuals who had previously participated in a Health Education England paid prior care experience pilot. Participant numbers at time point 1 were questionnaires n = 220, telephone interviews n = 10, and focus groups n = 8.

METHODS

Work package 1 consisted of longitudinal semi-structured telephone interviews. Work package 2 comprised validated online questionnaires measuring emotional intelligence, compassion satisfaction and fatigue, resilience, psychological empowerment, and career commitment (as proxies of compassionate values and behaviours), and focus groups. Qualitative data were thematically analysed. Quantitative data were analysed via Analysis of Variance in SPSS v 26.

RESULTS

Qualitative findings suggest that prior care experience has both positive and negative effects on students' compassionate values and behaviours, however positive effects do not extend to qualification. No statistically significant differences were found in any of the quantitative outcome measures between participants with and without paid prior care experience. A statistically significant increase in compassion fatigue was identified in both groups of participants post-qualification. Paid prior care experience did not prevent participants from experiencing reality shock on becoming a student or on qualification.

CONCLUSIONS

There is insufficient evidence of longitudinal beneficial impact to recommend paid prior care experience as an effective intervention to foster nursing students' compassionate values and behaviours. These findings do not support mandating a period of paid care experience as a prerequisite for entry into nurse education.

REGISTRATION

N/A. Tweetable abstract Insufficient evidence of longitudinal beneficial impact to recommend prior care experience as an effective intervention to foster nursing student compassion @PriorCareExp @Sarah_F_R.

Learnings from nursing bridging education programs: A scoping review

AIM

The aim of this scoping review is to summarize and critically evaluate research focused on nursing bridging education programs internationally. Specifically, this review addresses bridging from a: (1) Personal Support Worker (or similar) to a Registered Practical Nurse (or similar); and (2) Registered Practical Nurse (or similar) to a Registered Nurse.

BACKGROUND

Nursing bridging education programs support learners to move from one level of educational preparation or practice to another. These programs can therefore increase nursing workforce capacity. Global healthcare systems have faced nursing shortages for decades. Moreover, the presently insufficient nursing workforce is confronting an ever-increasing volume of needed healthcare that is rising with the global ageing demographic shift.

DESIGN

The Joanna Briggs Institute methods for scoping reviews, combined with Arksey and O'Malley's (2005) guidelines, were used with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR).

METHODS

MEDLINE (Ovid), CINAHL, EMBASE and SCOPUS databases were searched. Articles published in English that included Personal Support Workers, Registered Practical Nurses, Registered Nurses and/or nurses in similar categories who were studied through the process of a nursing bridging education program were included in the review. The study search was limited to papers published after 2005 (i.e., the beginning of nurse workload "overload" according to the Canadian Nurses Association). Braun and Clarke's (2006) thematic analysis was used in a content analysis of the included studies.

RESULTS

A total of 15 articles published between 2005 and 2022 were included. Four themes were generated: (1) participating in bridging education programs fuels both professional and personal development; (2) nursing bridging education programs enhance diversity in the nursing workforce; (3) student nurses do not anticipate the challenges associated with participating in a bridging program; and (4) mentor-mentee connection promotes academic learning and successful completion of nursing bridging education programs.

CONCLUSIONS

Despite experiencing challenges, participation in/completion of nursing bridging education programs leads to successful role transitioning and self-reported fulfillment of personal and professional aspirations. This review revealed the need for bridging programs to accommodate the unique needs of student nurses. Incorporation of support services, mentorship and faculty familiarity with varying nursing educational backgrounds facilitates role transitions by reducing the perceived challenges of bridging and promoting connection to foster learning. Nursing bridging education programs allow greater numbers of nurses to be trained to build workforce capacity and enable care for the world's rapidly ageing population.

Facilitators and Inhibitors of LPN-to-RN Student Transition: A Cross-Sectional National Survey

AIM

The aim of the study was to describe the transition conditions (facilitators and inhibitors) encountered by licensed practical nurses in registered nurse educational programs (LPN-to-RN students).

BACKGROUND

LPN-to-RN students are important because they may increase diversity and numbers of RNs. However, no prior study has examined transition experiences of LPN-to-RN students across the United States.

METHOD

A cross-sectional survey of LPN-to-RN students was conducted using Meleis et al.'s transition theory.

RESULTS

Students (n = 873) from 131 nursing programs responded. The most common facilitators were personal motivation and believing the content taught was valuable; the most common inhibitors were juggling multiple responsibilities and personal stress levels. Several significant relationships between transition conditions and program/student characteristics were identified.

CONCLUSION

Faculty in LPN-to-RN programs can increase support for students by refining their own actions and addressing potential challenges when LPN and non-LPN nursing students share classes.

The impact of care experience prior to commencing pre-registration nurse education and training: A scoping review

OBJECTIVES

Compassion in nursing and interventions to support it are of international relevance and concern. Prior care experience as a prerequisite for entry into pre-registration nurse education is suggested as a means of improving compassion. The impact of prior care experience has not been comprehensively reviewed, therefore the potential effectiveness of prior care experience as a means of improving compassion is unknown. The scoping review question was 'What is known about the impact of care experience prior to commencing pre-registration nurse education and training?' The primary objective was to scope and synthesise existing literature relating to the topic and ascertain key themes pertaining to impact. A secondary objective was to appraise literature, to contextualise findings and assess the state and stage of knowledge and research in the area.

DESIGN

The review was guided by Arksey and O'Malley's methodological framework and is reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews Checklist.

DATA SOURCES

Health sciences databases CINAHL, Medline and PubMed.

METHODS

Databases were searched in February 2019, updated August 2021. Data (study characteristics, findings, methodological observations) were extracted from papers meeting inclusion criteria (including peer-reviewed empirical papers with English language, electronic full-text available) and findings thematically analysed.

RESULTS

Forty-five papers from 14 countries were included. The majority (64.4 %) were published in Europe (31.1 % in the United Kingdom) between 2010 and 2021 (69 %), 60 % from 2013. Four qualitative themes (compassionate care, commitment, competence and communication) describe the impact of prior care experience, which was variable.

CONCLUSIONS

Evidence to support the effectiveness of prior care experience as a prerequisite for entry into nurse education to improve compassion, is inconsistent and insufficient. The literature displays methodological limitations and conclusions should be interpreted in light of these caveats. Recommendations are made for future research, to improve quality and comparability.

Learning transfer and transition of certified nursing assistants' to baccalaureate nursing programs

BACKGROUND

Certified nursing assistants (CNAs) provide vital care to patients in a variety of care settings, yet little is known about their transition and transfer of learning to baccalaureate nursing education. Faculty play a key role in helping them successfully progress through their educational journey.

PROCEDURE

Using a qualitative descriptive design, semi-structured interviews of eight CNAs enrolled in U.S. schools in the south-central region of Pennsylvania were conducted. Data were analyzed using content and thematic analysis.

RESULTS

The influence of prior health care experience afforded participants confidence in their transition to BSN education, as well as accelerated learning. Three themes emerged from participant data related to transfer of learning: jumping in and demonstrating confidence from the beginning, learning from a foundation to transform my thinking from tasks to process, and merging new learning into practice. Results support that even if CNAs face varying challenges entering nursing education, most possess some clinical reasoning and critical thinking skills, as well as experience working with patients and within teams.

CONCLUSIONS

All of which can influence the learning experience. Findings can help faculty identify CNAs' strengths, which may facilitate learning transfer, foster leadership potential, and engage them in peer teaching and mentoring; ultimately positively influencing the transition to practice.

A review of Operating Department Practitioner students' experiences of clinical placements as a result of changing organisations in each academic year

Operating Department Practitioner students as part of their education undertake placements that enable them alongside their academic studies to meet the Health and Care Professions Council Standards of Proficiency; however, like all education providers there was an annual shortage of appropriate placements. As a result, the organisation involved in this review needed to explore an alternative approach to allocating clinical placements. In addition, the course team wanted to change how students gained their clinical skills and possibly increase their understanding of the Operating Department Practitioner role. Traditionally the institution involved (like other Operating Department Practitioner education providers) placed students in one organisation for all of their clinical placements unlike other professions such as nursing who placed students in different areas. The review resulted in students being placed in a different organisation in each year of their course. A qualitative methodology in the form of focus groups was employed to review students' views of the change and their clinical experiences. This resulted in students highlighting areas such as readiness for being qualified and links to evidenced-based practice as benefits of the new system. The review has been successful in terms of placement numbers but also student experiences, although an ongoing review is being undertaken, the change has been successful.

Altered nursing student perspectives: Impact of a pre-clinical observation experience at an outpatient oncology setting

This study examined the influence of an observation experience at an outpatient oncology setting on first-year nursing students. This experiential learning opportunity occurred prior to any formal clinical practice course. A hermeneutic phenomenology approach was used to uncover pre-licensure nursing students' perspectives about cancer, as well as their understanding of the roles and responsibilities of registered nurses in cancer care both before and following their experience. A total of 10 nursing students agreed to participate in the study. Data were collected through semi-structured interviews following which data were analyzed and interpreted to understand the meaning in the experience. Two overarching themes were identified including circles of relationships, and the many sides of outpatient oncology. This study reveals that experiential learning in the form of a low-risk, observation-only experience may be an opportunity for pre-licensure students to gain new perspectives about cancer care and nurses roles in caring for individuals and families who are impacted by cancer.

"Am I a student or a Healthcare Assistant?" A qualitative evaluation of a programme of prenursing care experience

AIM

To examine the experiences of prenursing healthcare assistants (HCA) during a 6-month programme of prenursing care experience.

BACKGROUND

Care experience prior to commencing programmes of nurse education is broadly considered to be advantageous. However, it is not clear how formal care experience prior to nurse education has an impact on the values and behaviours of the aspirant nurse.

DESIGN

A longitudinal prospective qualitative study using focus group discussions.

METHODS

Data were collected from 23 prenursing HCA during September 2013-February 2014. Three focus groups were held at the beginning, middle, and end of the programme of care experience at each of the participating hospitals. A thematic analysis was used to analyse data sets from each hospital. Findings from each hospital were then compared to reach final themes.

RESULTS

Five major themes were identified in the analysis of qualitative data: personal development; positioning of role in the healthcare team; support and supervision; perceived benefits; and advice and recommendations. These themes were underpinned by deep aspirations for better care and better nurses in the future.

CONCLUSIONS

Prenursing care experience can positively prepare aspirant nurses for programmes of nurse education. The benefits identified were confirmation of aspiration (or otherwise) to pursue nursing, learning opportunities, and aspiration to improve patient experience. Risks for the programme included poor supervision, role ambiguity or confusion, demotivation through a deteriorating view of nursing, and poor treatment by others. The longer term impact on values and behaviours of this cohort requires further evaluation.

'Doing it for real now' - The transition from healthcare assistant to newly qualified nurse: A qualitative study

BACKGROUND

There has been increasing international research and policy interest concerning the transition from student to newly qualified nurse (NQN). However, the influence of previous employment as a healthcare assistant (HCA) on students' experiences of this transition is comparatively under-researched.

AIMS AND OBJECTIVES

To explore the experiences of NQNs also employed as HCAs during their pre-registration education programme and how this prior and ongoing HCA experience influenced their transition experiences.

DESIGN

Qualitative research design using a descriptive method.

SETTING AND PARTICIPANTS

Former students (n = 14) of a unique four year, part-time, employer-sponsored pre-registration nursing programme, specifically designed for HCAs and delivered by supported open learning, located in different regions and nations of the United Kingdom who had qualified within the last two years.

METHODS

Telephone interviews, digitally recorded, transcribed verbatim and analysed using NVivo8.

RESULTS

Four themes described participants' experiences of transition: In at the deep end, Changing identities, Coming together and Scaffolding. Findings confirm existing literature that all NQNs appear to experience a similar overarching experience of transition, including those with prior HCA experience. However, familiarity with people, place and routines afforded by this previous experience appeared to ease transition, particularly if the NQNs stayed in their previous HCA work location. However, managing the dual roles of being both HCA and student and adapting to their changing identities were frequently cited as particular challenges.

CONCLUSIONS

Van Gennep's Rites de Passage and Bridge's work on organisational change were combined to theoretically analyse participants' accounts of transition. This illustrated that transition is not always linear with clearly defined and bounded stages but can also be seen as a more undulating or organic process with curving, slanting and overlapping phases. NQNs can therefore simultaneously occupy more than once phase in their journey of transition. Implications for students, higher education and practice are highlighted.

Nursing students' socialisation into practical skills

Socialisation is a significant factor that shapes nursing students' learning in clinical settings. Little is known about the ways in which students learn practical skills during their clinical practice and how they are socialised into these skills. This knowledge is important for creating an optimal environment for ensuring a high standard of care and patient safety. This study aims to address this knowledge gap. An ethnographic approach was used. Data were collected by participant observations during nursing students' clinical practice in an emergency department at a university hospital in Sweden, and during informal conversations with students and their preceptors. In the analysis, four themes emerged: A reflective approach based on a theoretical framing; Multitasking situations; Shifts in an active role as a nursing student; and Styles of supervision. Students' socialisation into practical skills was shaped by several factors where preceptors played a key role. Teaching and learning styles and interactions between the preceptor and the student shaped the learning situations. A dominant discrepancy regarding whether and how reflections took place between preceptors and students was identified. This highlights the need for creating continuity between the ways that experiences are organised across the settings of learning (university-based and clinically based learning) to enhance nursing students' learning and socialisation into practical skills.

Finessing incivility: The professional socialisation experiences of student nurses' first clinical placement, a grounded theory

BACKGROUND

Clinical practice is where student nurses are socialised into a professional role and acquire the distinct behaviour, attitudes and values of the nursing profession. Getting it right at the outset can maximise the development of a professional identity and the transmission of robust value systems.

OBJECTIVES

To explore the impact of the first clinical placement on the professional socialisation of adult undergraduate student nurses in the United Kingdom.

DESIGN

Data of a longitudinal qualitative nature were collected and analysed using grounded theory.

SETTINGS

First year student nurses in hospital ward placements comprising a rural District General Hospital and a large inner city Hospital kept daily unstructured diaries for six weeks.

PARTICIPANTS

A total of 26 undergraduate adult student nurses were purposefully sampled between 2008 and 2010 before undertaking their initial clinical placement.

METHODS

Data collection and analysis used grounded theory and the key question asked of the diarists 'tell me what it is like to be a first year nurse on a first placement' was theoretically adjusted during constant comparison and as the theory emerged. Ethical approval and consent was obtained.

RESULTS

The theory of finessing incivility comprises a conceptual framework depicting how student nurses deal with professional incivility during their initial clinical placement and sustain a student identity. Being disillusioned with their role as worker rather than learner yields a sense of 'status dislocation'. Despite needing professional benevolence, they remain altruistic and seek recompense from significant others to negotiate for learning opportunities and relocate their student status.

CONCLUSIONS

Despite the stressful transition into clinical practice rather than 'fit in', the student nurses want to belong as learners. His or her own resilience to learn nursing and be a professional student maintains their resolve, their altruism and strengthens their existing values to be benevolent towards an indifferent profession. This behaviour ultimately mirrors the social nature of the practice community.

Personal Beliefs and Professional Responsibilities: Ethiopian Midwives' Attitudes toward Providing Abortion Services after Legal Reform

In 2005, Ethiopia liberalized its abortion law and subsequently authorized midwives to offer abortion services. Using a 2013 survey of 188 midwives and 12 interviews with third-year midwifery students, this cross-sectional research examines midwives' attitudes toward abortion to understand their decisions about service provision. Most midwives were willing to provide abortion services. This willingness was positively and significantly related to clinical experience with abortion, but negatively and significantly related to religiosity, belief that providers have the right to refuse to provide services, and care of patients from periurban as opposed to rural areas. No significant relationship was found with perceptions of abortion stigma, years of work as a midwife, or knowledge of the law. Interview data suggest complex dynamics underlying midwives' willingness to offer services, including conflicts between professional norms and religious beliefs. Findings can inform Ethiopia's efforts to reduce maternal mortality through task-shifting to midwives and can aid other countries that are confronting provider shortages and high levels of maternal mortality and morbidity, particularly due to unsafe abortion.

'Ready to hit the ground running': Alumni and employer accounts of a unique part-time distance learning pre-registration nurse education programme

BACKGROUND

This study explored the impact of The Open University's (OU) preregistration nursing programme on students' employability, career progression and its contribution to developing the nursing workforce across the United Kingdom. Designed for healthcare support workers who are sponsored by their employers, the programme is the only part-time supported open/distance learning programme in the UK leading to registration as a nurse. The international literature reveals that relatively little is known about the impact of previous experience as a healthcare support worker on the experience of transition, employability skills and career progression.

OBJECTIVES

To identify alumni and employer views of the perceived impact of the programme on employability, career progression and workforce development.

DESIGN/METHOD

A qualitative design using telephone interviews which were digitally recorded, and transcribed verbatim prior to content analysis to identify recurrent themes.

SETTINGS

Three geographical areas across the UK.

PARTICIPANTS

Alumni (n=17) and employers (n=7). Inclusion criterion for alumni was a minimum of two years' post-qualifying experience. Inclusion criteria for employers were those that had responsibility for sponsoring students on the programme and employing them as newly qualified nurses.

RESULTS

Four overarching themes were identified: transition, expectations, learning for and in practice, and flexibility.

CONCLUSIONS

Alumni and employers were of the view that the programme equipped them well to meet the competencies and expectations of being a newly qualified nurse. It provided employers with a flexible route to growing their own workforce and alumni the opportunity to achieve their ambition of becoming a qualified nurse when other more conventional routes would not have been open to them. Some of them had already demonstrated career progression. Generalising results requires caution due to the small, self-selecting sample but findings suggest that a widening participation model of pre-registration nurse education for employed healthcare support workers more than adequately prepares them for the realities of professional practice.

Deviations from venous blood specimen collection guideline adherence among senior nursing students

BACKGROUND

Despite considerable efforts to increase patient safety by supporting the use of best practice medical and nursing guidelines by healthcare staff, adherence is often suboptimal. Swedish nurses often deviate from venous blood specimen collection (VBSC) guideline adherence. We assessed the adherence to national VBSC guidelines among senior nursing students.

METHODS

We conducted a cross-sectional, self-reported questionnaire survey among 101 out of 177 senior nursing students consisting of web-based students in their fifth semester and campus-based students in their fifth or sixth semester out of six. In regard to the VBSC procedures, we asked about adherence to the patient identification, test request handling, and test tube labelling protocols that the students had learned during their second semester and practiced thereafter.

RESULTS

Guideline adherence to patient identification was reported by 81%, test request handling by 74%, and test tube labelling by 2% of the students. Students with no prior healthcare education reported to a higher extent that they operated within the guidelines regarding labelling the test tube before entering the patient's room compared to students with prior healthcare education. Using multiple logistic regression analysis, we found that fifth semester web-based program students adhered better to VBSC guidelines regarding comparing patient ID/test request/tube label compared to campus-based students.

CONCLUSIONS

Senior nursing students were found to adhere to VBSC guidelines to a similar extent as registered nurses and other hospital ward staff in clinical healthcare. Thus student adherence to VBSC guidelines had deteriorated since their basic training in the second semester, and this can impact patient safety during university/clinical studies. The results of our study have implications for nursing practice education.

'Newcomer adaptation': a lens through which to understand how nursing students fit in with the real world of practice

Aims and objectives

To present a discussion on newcomer adaptation as a lens through which to understand how nursing students adapt to clinical practice and raise awareness of strategies that can be used to enhance their learning experiences.

Background

Socialisation is an important factor that facilitates students’ learning in the clinical setting. Therefore, it is beneficial to examine organisational socialisation literature, particularly that pertaining to newcomer adaptation.

Design

This is a critical review of organisational socialisation literature.

Methods

Seminal literature and more recent research in the field of organisational socialisation and newcomer adaptation were accessed. In addition, nursing and allied health literature examining students’ socialisation and the clinical learning environment was retrieved.

Conclusions

It is revealed in this article that to create an appropriate clinical learning environment, an understanding of socialisation tactics could be beneficial. Role modelling is deemed crucial to successful newcomer adaptation. Peer support is necessary but must be advocated with caution as it can have a negative impact when students form a ‘parallel community’. Students with some knowledge of the workplace tend to adapt more easily. Likewise, students’ disposition and, in particular, their confidence can also enhance the socialisation process.

Relevance to clinical practice

Both the organisation and the student can impact on how successfully the nursing student ‘fits in’. Understanding this through the lens of newcomer adaptation means that strategies can be put in place to facilitate this process.

A qualitative study exploring the impact of student nurses working part time as a health care assistant

BACKGROUND

National and international evidence indicates that university students engage in employment whilst studying. Research has suggested that nursing students either enter training with previous care experience or tend to work part time in a health related area whilst undertaking higher education. The impact of this on the socialisation process remains unclear.

OBJECTIVES

Based on the symbolic interactionist framework, this paper reports on a theme from a large mixed methods study - the extent and implications of student nurses' work experience on learning and training.

DESIGN

One qualitative stage from a sequential exploratory mixed methods design.

SETTINGS

One higher education institution in the United Kingdom.

PARTICIPANTS

Forty-five pre-registration nursing students.

METHODS

Thirty-two students took part in four focus groups and 13 took part in individual interviews.

RESULTS

Findings revealed that 27 (60%) of students were in paid nursing related employment. This was reported to be advantageous by most participants with regards to enhancing confidence, skills and time spent in the clinical setting. However, it was also perceived by a small number of participants as being detrimental to subsequent learning resulting in role confusion, influencing placement behaviour, and preferences for future nursing practice. Student participants with no prior work experience believed this placed them at a disadvantage, negatively influencing their learning, ability to fit in, and adjustment on placement. Findings have suggested that student participants desire more recognition of the experience and skills they have gained from their employment.

CONCLUSIONS

Whilst care experience among the student nursing population is advocated, the results of this study show that it is perceived to impinged on their learning and educational journey. Policy makers, educationalists and health service providers need to be aware of the students who operate within the dual roles of student and health care worker so as to provide guidance and appropriate direction.

Students' experiences of implementing clinical skills in the real world of practice

AIMS AND OBJECTIVES

To examine the factors that impact on students' implementation of clinical skills in the practice setting. This was a part of a larger exploration into the role of the Clinical Skills Laboratory in preparing student nurses for clinical practice.

BACKGROUND

It is already known that students can experience reality shock on clinical placement and that staff support is crucial for their adaptation to the environment. This process is similar to socialisation theory whereby the newcomer adapts to the workplace.

DESIGN

A multiple case study design (n = 5) was used.

METHODS

Data were collected using semi-structured interviews (n = 43) and non-participant observation of students implementing skills in clinical practice.

RESULTS

Findings revealed the factors that could facilitate students' implementation of clinical skills were as follows: provision of learning opportunities, staff support and supervision, and students' confidence. Factors that hindered students were reality shock, 'the gap' in how skills were taught in the higher education institutions and the clinical setting, and missed learning opportunities. Support from peers in the clinical area and having previous experience of working as a health care assistant, or similar, were the factors that could either positively or negatively impact on students.

CONCLUSIONS

Students need to be adequately prepared for the real-life clinical environment. Understanding, through socialisation theory, how students adapt to the workplace can facilitate this process. Facilitating students' learning includes supporting them, developing their confidence and ensuring that they have prior exposure to undertaking clinical skills.

RELEVANCE TO PRACTICE

Staff working with students in clinical practice can help facilitate students' learning and implementing of clinical skills through an understanding of how students adapt and 'fit in' to their working environment.

Resilience to care: a systematic review and meta-synthesis of the qualitative literature concerning the experiences of student nurses in adult hospital settings in the UK

AIM

The aim of the study was to gain new insights into the experiences and accounts of adult pre-registration student nurse clinical allocations in hospital settings in the UK.

DESIGN

A systematic review and meta-synthesis of the qualitative literature was undertaken.

DATA SOURCES

Pertinent papers published from 1990 to 2010 were identified through searches of Cumulative Index for Nursing and Allied Health Literature, Proquest, Medline (PubMed), and the British Nursing Index. Hand and citation searching was also undertaken.

REVIEW METHODS

Ten relevant papers were identified for review. Quality checks on the robustness of the studies were undertaken. Data extraction included identifying details of the study's settings, sample details, focus of the study, research design, data collection methods, data analysis approaches and qualitative data themes.

RESULTS

Approximately 40 qualitative data themes were identified and were the subject of a meta-synthesis. Five cross-cutting synthesised data themes were identified including: pre-placement anticipation, the realities of the clinical environment, clinical learning and becoming a nurse. Stress and coping was a concurrent topic area and related to all the synthesised themes.

CONCLUSIONS

The findings give new insights into the clinical experiences of student nurses of which the stress of learning in clinical environments and the development of emotional resilience is a focal issue. Whilst the majority of students in the UK experience nurturing, caring clinical environments and positive staff relationships, however, some do not. Reports of negative student nurse clinical experiences are shown in this review to have endured through time. Nurse educators should be alert to the possibility that some students may have very negative clinical experiences. The consequences such negative experiences will affect such things as increases to student attrition and the help perpetuate the cycle of negative clinical learning experiences occurring in the future.

The feelings of guilt and shame experienced by Nursing and Midwifery students

AIM

Feelings of guilt and shame might affect the abilities of nursing and midwifery students when fulfilling their roles assertively and with professional autonomy during the interdisciplinary care and treatment process. The present study was conducted in order to examine the feelings of guilt and shame experienced by nursing and midwifery students with respect to certain variables.

METHODS

The population of this study, which had a cross-sectional design, comprised a total of 1002 students from three training locations: a school of nursing, the nursing program of a health vocational school, and the midwifery program of a health vocational school. From this population, 667 students were recruited to the study by a stratified random sampling method. Personal Information Forms and a Guilt-Shame Scale were used as data collection tools.

RESULTS

From amongst the students, 88.6% were women. The average age was 20.57 years; the mean scores of the guilt and shame subscales were 50.51 and 43.63, respectively. Statistically significant differences were observed between the guilt-shame scores of the students by the variants of gender, age, school, and year at school.

CONCLUSIONS

The present study concluded that midwifery and nursing students experience measurable feelings of guilt-shame and that the levels of guilt-shame had an impact on their targets regarding nursing/midwifery. Therefore, it is suggested that guidance programmes be established and that the related problems be resolved.