Nursing students in clinical practice – Developing a model for clinical supervision

Augmented Reality in Supporting Healthcare and Nursing Independent Learning: Narrative Review

New advances in technology have brought challenges and opportunities for education and instructional methods. Compared with traditional education, the increased use of technology-enhanced blended learning in healthcare and nursing education requires students to take more responsibility for their learning. The use of advanced technology has resulted in independent learning skills becoming increasingly important. Many studies have reported a positive correlation between independent learning and success rates in an e-learning environment. This paper focuses on the potential contribution of augmented reality, which superimposes layers of virtual content on real physical objects. The paper initially presents a narrative literature review to identify augmented reality's strengths and challenges in facilitating independent learning and highlights several potential approaches for utilizing augmented reality in nursing education. However, it also reveals a lack of studies integrating augmented reality and independent learning theories such as self-regulated learning. The paper then addresses this gap by proposing a new learning approach to support independent learning.

What Helps, What Hinders? Undergraduate Nursing Students' Perceptions of Clinical Placements Based on a Thematic Synthesis of Literature

Introduction

Clinical placements are a mandatory component of nursing students’ education internationally. Despite clinical education being a key to nursing students’ achievement of nursing competencies, few studies have reviewed students’ narratives to describe their experiences of learning during clinical placement. Such studies may be important in offering a deeper insight into clinical learning experiences than quantitative surveys.

Methods

A systematic thematic synthesis of qualitative studies between 2010 and June 2020 was conducted. English language studies that offered a thematic analysis of undergraduate nursing students’ experiences of learning during placement were sought. A search was made of five databases PubMed, Ovid Medline, CinahlPlus, SCOPUS, and Google Scholar. The study was guided by the ENTREQ statement for enhancing transparency in reporting the synthesis of qualitative research.

Results

Twenty-seven qualitative studies were included in the review. A thematic synthesis showed over 100 themes and subthemes across the studies. A cluster analysis revealed positive elements and others that were seen in the studies as a barrier (hindrance) to clinical learning. Positive elements included supportive instructors, close supervision, and belonging (in the team). Unsupportive instructors, a lack of supervision and not being included were seen as a hindrance. Three key overarching themes that could describe a successful placement were revealed as “Preparation,” “Welcomed and wanted” and “Supervision experiences”. A conceptual model of clinical placement elements conducive to nursing students’ learning was developed to enhance understanding of the complexities associated with supervision. The findings and model are presented and discussed.

Conclusion

The conceptual model presents positive elements that influence students’ clinical placement experiences of learning. This model may provide a framework to guide professional development programs and strategies to support students and supervisors alike, an important step forward in moving beyond the current clinical placement rhetoric.

The effect of peer support approach on communication skills of nursing students in pediatric clinical setting

Peer support is a valuable teaching-learning approach to enhance deep learning in the clinical environment. The purpose of the present study was to investigate the effect of peer support on the communication skills of undergraduate nursing students when interacting with hospitalized children and their parents. This was a pre-and post-test quasi-experimental study with two groups. Through the cluster random sampling method, six practical groups of students who undertook a 3-week pediatric practicum were selected. Three groups were allocated to the experimental (n = 51) and control groups (n = 52). Two volunteer post-graduate students in pediatric nursing formed the peer group. First, the peers participated in three 45-min sessions using different scenarios about communication skills. They then tutored the intervention group to improve their communication skills. The communication skills with 5 children and 5 parents were observed for each undergraduate student via the checklist. The experimental group demonstrated significantly higher mean scores of the communication skills than the control groups in post-test (P < 0.001). Moreover, the mean scores of communication skills was significantly higher in post-test than pre-test in both the experimental and control groups (p < 0.001). Peer support approach promoted the communication skills of undergraduate nursing students in pediatric clinical setting.

Exploring the barriers of utilizing theoretical knowledge in clinical settings: A qualitative study

OBJECTIVES

Although effective performance in clinical settings requires the integration between theory and practice, there is a gap between theoretical knowledge as taught in the classroom and what the students experience in clinical settings. This study aimed to elicit and explore the barriers of utilizing theoretical knowledge in clinical settings.

METHODS

A qualitative study was adopted with a conventional content analysis approach. Fifteen nursing and paramedic's students, faculty members and experienced nursing staff participated in the study. Data were collected by semi-structured individual interviews until data saturation and concurrently analyzed via MAXQDA 10.

RESULTS

Five main categories emerged as barriers of utilizing theoretical knowledge in the clinical settings i.e. non-standard practices in clinical settings; lack of trust in clinical competence; lack of perceived professional support; insufficiencies in teaching and learning process; and differences between doing things in simulated and real clinical situations.

CONCLUSION

Transferring theory into practice in a structured manner requires professional support in the workplace, trust and the opportunity for direct experience, using valid and up-to-date knowledge by clinical staff and bridging the simulated situations with real life scenarios.

Clinical Supervision and Support: Exploring Pre-registration Nursing Students' Clinical Practice in Malawi

Background:

Supervised clinical practice plays a significant role in the nursing profession, as it has an influence on the students’ clinical learning.

Objectives:

The aim of this study was to explore how the pre-registration nursing students find their experience on clinical supervision in the clinical placements.

Methods:

The study used both quantitative and qualitative approach to collect data through focus groups (n = 144) and self-administered questionnaires (n = 590) from nursing students of various programmes in selected colleges in Malawi.

Results:

About 75% (n = 443) of the participants indicated that they received supervision from both clinical staff and Nurse Educator. However, qualitative results indicated that students received inadequate clinical supervision. Themes that emerged from the discussion included lack of human resources, learning support, availability of instructors yet not supporting learning, job insecurity and lack of remuneration as reasons for lack of supervision, role models and student guidance despite pressure and self-directed.

Conclusion:

There is a need for clear policies regarding clinical supervision as well as a structured and well monitored process.

Clinical learning environment and supervision of international nursing students: A cross-sectional study

BACKGROUND

Previously, it has been shown that the clinical learning environment causes challenges for international nursing students, but there is a lack of empirical evidence relating to the background factors explaining and influencing the outcomes.

OBJECTIVE

To describe international and national students' perceptions of their clinical learning environment and supervision, and explain the related background factors.

DESIGN

An explorative cross-sectional design was used in a study conducted in eight universities of applied sciences in Finland during September 2015-May 2016.

METHODS

All nursing students studying English language degree programs were invited to answer a self-administered questionnaire based on both the clinical learning environment, supervision and nurse teacher scale and Cultural and Linguistic Diversity scale with additional background questions. Participants (n=329) included international (n=231) and Finnish (n=98) nursing students. Binary logistic regression was used to identify background factors relating to the clinical learning environment and supervision.

RESULTS

International students at a beginner level in Finnish perceived the pedagogical atmosphere as worse than native speakers. In comparison to native speakers, these international students generally needed greater support from the nurse teacher at their university. Students at an intermediate level in Finnish reported two times fewer negative encounters in cultural diversity at their clinical placement than the beginners.

CONCLUSION

To facilitate a successful learning experience, international nursing students require a sufficient level of competence in the native language when conducting clinical placements. Educational interventions in language education are required to test causal effects on students' success in the clinical learning environment.

Competencies to enable learning-focused clinical supervision: a thematic analysis of the literature

CONTEXT

Clinical supervision is essential for development of health professional students and widely recognised as a significant factor influencing student learning. Although considered important, delivery is often founded on personal experience or a series of predetermined steps that offer standardised behavioural approaches. Such a view may limit the capacity to promote individualised student learning in complex clinical environments. The objective of this review was to develop a comprehensive understanding of what is considered 'good' clinical supervision, within health student education. The literature provides many perspectives, so collation and interpretation were needed to aid development and understanding for all clinicians required to perform clinical supervision within their daily practice.

METHOD

A comprehensive thematic literature review was carried out, which included a variety of health disciplines and geographical environments.

RESULTS

Literature addressing 'good' clinical supervision consists primarily of descriptive qualitative research comprising mostly small studies that repeated descriptions of student and supervisor opinions of 'good' supervision. Synthesis and thematic analysis of the literature resulted in four 'competency' domains perceived to inform delivery of learning-focused or 'good' clinical supervision. Domains understood to promote student learning are co-dependent and include 'to partner', 'to nurture', 'to engage' and 'to facilitate meaning'.

CONCLUSIONS

Clinical supervision is a complex phenomenon and establishing a comprehensive understanding across health disciplines can influence the future health workforce. The learning-focused clinical supervision domains presented here provide an alternative perspective of clinical supervision of health students. This paper is the first step in establishing a more comprehensive understanding of learning-focused clinical supervision, which may lead to development of competencies for clinical supervision.

Support in Clinical Settings as Perceived by Nursing Students in Iran: A Qualitative Study

Background

Although support is one of the most substantial needs of nursing students during clinical education, it is not clearly defined in the literature.

Objectives

The current study aimed to explore the concept of support in clinical settings as perceived by nursing students.

Materials and Methods

A qualitative content analysis was used to explore the meaning of student support in clinical settings. A purposive sampling with maximum variation was used to select the participants among bachelor nursing students in the nursing school of Babol University of Medical Sciences in the north of Iran. Semi-structured interviews were conducted to gather the perceptions and experiences of seventeen nursing students. Conventional content analysis was applied to analyze the data.

Results

In the current study, the main theme, nurturance, was emerged with seven subthemes of humanistic behavior with the student, respectful communication with students, accepting the student in the clinical setting, sustaining confidence, need based supervision, accepting the profession in the society and empowerment.

Conclusions

Nursing students support in the clinical education requires a nurturing care; a care that leads to the sense of worthiness and respectability in students and contributes to the improvement of their clinical abilities.

Work Role Perspectives of Clinical Instructors From Three Countries

BACKGROUND

Educational institutions partner with health facilities to provide clinical education, but the impact of these partnerships on clinical instructors is rarely examined.

METHOD

A cross-sectional study was used to obtain surveys from a convenience sample of clinical instructors (n = 135) working in Israel, Norway, and the United States. The Nursing Clinical Instruction Role Assessment Tool (N-CIRAT) was developed to elicit clinical instructors' perspectives on the importance and nature of their work roles.

FINDINGS

The N-CIRAT exhibited good reliability and revealed three different work roles: educator, hospital partner, and patient advocate. The educator work role did not differ by primary employer; it did for the work role of hospital partner (p < .05) and patient advocate (p < .05). Patient advocate work role importance was rated high for all clinical instructors.

CONCLUSION

The educator role of clinical nurse educators, including being a role model and encouraging reflection, is universal among clinical instructors.

The effect of clinical supervision model on high alert medication safety in intensive care units nurses

BACKGROUND

Medication errors and adverse drug events of high alert medication are one of the major problems in therapeutic system. The purpose of the present study was to investigate ύthe effect of clinical supervision model on high alert medication safety in intensive care units nurses.

MATERIALS AND METHODS

This was a quasi-experimental study conducted on 32 nurses of intensive care units. The researcher observed the administration of high alert drugs including heparin, warfarin, norepinephrine, dobutamine, and dopamine by nurses and recorded the scores of the work in preventing medication errors, the work in preventing adverse drug events, and medication safety. Then, the researcher performed clinical supervision model and during performance of the model, the researcher reassessed the score of the work in preventing medication errors, The work in preventing adverse drug events and medication safety. Tool of data collection was action plan of high alert medication safety checklists (heparin, warfarin, norepinephrine, dobutamine, and dopamine checklists).

RESULTS

The result of the statistical trials showed that before and after applying the clinical supervision model, there was a statistically significant difference between the average scores of medication safety of heparin (15.7 vs 18.73), warfarin (11.08 vs 15.67), norepinephrine (14.60 vs 19.72), dobutamine (13.80 vs 19.30), and dopamine (14.25 vs 19.47).

CONCLUSIONS

Based on the results of this study, it seems that administration of clinical supervision model in intensive care units can lead to improving the status of safety of high alert medication.

Developing preceptorship through action research: Part 1

Clinical preception in practice plays a significant role in both registered and practical nurse studies. As such, the cooperation between the faculty and working life is important to narrow the theory-practice gap, with emphasis being placed on a student-oriented approach promoting self-direction and lifelong learning. The aim of this project was to develop the preceptorship at five different units within the health-care sector in western Finland by implementing an action research (AR) approach. This article is the first of a two-part article on the project, focusing on a cultural analysis and the development of preception models conducted within the project. The five units participating in the study were the following: a long-term care ward in the community, a ward for people with dementia, a geriatric ward, a medical ward and a surgical ward representing specialised care. The starting point of the study was a cultural analysis, which was made in all the five units to obtain a 'bottom-up' perspective. In each of the five units 3-5 nurses were appointed to become members of the core groups. This meant that all the units would start from the perspective of their own working environment when creating a preception model that would fit into their particular workplace. During this process, the participants received continuous support from the researchers. Several workshops and seminars were also arranged to further support the core groups and staff. The models were implemented and tested during the academic year 2010-2011 followed by an evaluation of the project. The evaluation results will be presented in the second part of the two-part article. The project showed that reflective practice and critical thinking can be improved through an AR approach.

Perspectives on good preceptorship: A matter of ethics

BACKGROUND

Clinical education is an essential part of the Bachelor's program in Nursing and a keystone of professional nursing education. Through clinical experiences, the student nurses acquire nursing knowledge and essential skills for professional practice. The preceptor plays a vital role in the development of student nurses becoming professional nurses.

AIM

The aim of this Nordic qualitative study was to explore the experiences of good preceptorship in relation to undergraduate student nurses in clinical education from the perspective of the preceptors themselves.

METHOD

Data were collected by narrative interviews with 27 preceptors in Finland and Sweden and analyzed using a hermeneutical approach.

FINDINGS

A caring relationship, based on caring ethics, is seen as the foundation for learning and development. Moreover, a mutual respect is a prerequisite for fellowship and a good atmosphere. As such, encounters are characterized by reciprocity and mutuality. The preceptors have a deep sense of responsibility toward the students and the profession. Furthermore, the preceptors have an inner responsibility to guide the students into working life and to share their knowledge by acting as role models.

CONCLUSION

The findings suggest that preceptorship should be examined through new lenses. Moreover, preceptorship is an ethical issue that should be recognized by all stakeholders.

Finnish and Swedish nursing students' experiences of their first clinical practice placement--a qualitative study

BACKGROUND

Nursing is a practice-based discipline. Clinical practice settings are important in preparing undergraduate nursing students for the role of registered nurse.

AIM

The aim of this Nordic qualitative study is to illuminate first year undergraduate nursing students' experiences of clinical practice during their first clinical placement, with a focus on preception, reflection, and the link between theory and practice.

METHOD

Data were collected by focus group interviews with 22 nursing students, and analyzed with qualitative content analysis.

FINDINGS

Positive experiences included stimulating and visible preceptors, a permissive atmosphere, and reflection as a matter of course. Negative experiences were related to feelings of abandonment and powerlessness when preceptors were invisible and the atmosphere at the ward was non-permissive. The implementation of research-based knowledge was insufficient.

CONCLUSIONS

A permissive atmosphere and visible preceptors are crucial if learning is to be maximized. Consequently, it is important to set aside time for preceptors to be more visible and to make the atmosphere at the clinical placement more permissive. The student must have the opportunity to combine scientific knowledge with evidence-based knowledge in order to develop nursing actions.

Genetic counseling supervisor competencies: results of a Delphi study

Clinical supervision is a critical component of genetic counseling student preparation, yet empirically-determined competencies for genetic counseling supervisors are lacking. In this study a modified, two-round Delphi method was used to gain consensus about important genetic counseling supervisor knowledge, characteristics, and skills. Program directors and assistant directors of American Board of Genetic Counseling accredited genetic counseling programs in North America (N = 33) were invited to participate and to recruit three experienced supervisors. Seventy-four individuals completed Round 1 and, of these, 61 completed Round 2. Approximately two-thirds were clinical supervisors from prenatal, pediatrics, cancer, and adult clinics; one-third were program directors. Participants rated the importance for genetic counseling supervisors of 158 items derived from supervision literature in allied health professions. They rated 142 items (89.9 %) as highly important. Content analysis of these items yielded six supervisor competency domains: Personal traits and characteristics; relationship building and maintenance; student evaluation; student centered supervision; guidance and monitoring of patient care; and ethical and legal aspects of supervision. The results provide a basis for training genetic counseling supervisors and for further research to refine and validate supervisor competencies.

Perioperative death: a critical reflection-on-action

Perioperative death is thankfully not a regular occurrence in UK operating theatres. However, when it does occur the perioperative practitioner is often denied the opportunity to grieve. The use of a clinical supervision session enabled a critical reflective approach to be followed after the death of a patient in the operating theatre.

Nursing students' perceptions of tutorial strategies during clinical learning instruction: A descriptive study

CONTEXT

Teaching strategies and methodology used in clinical training are varied and have different levels of outcome.

METHODS

A descriptive study was carried out in Italy on a convenience sample of third year students at four campuses of the Verona University, using a questionnaire divided into four sections: trainees' perception of the levels of usefulness of various teaching strategies, the levels of effectiveness, the level of supervision and the perceived complexity.

RESULTS

308 students compiled the questionnaire. All the tutorial strategies included were perceived as having medium to high levels of usefulness, ten out of the eleven learning strategies were found to be very useful. A medium-high level of usefulness was perceived for supervision (M 2.9±1). The two skills recorded as needing the most supervision were the management of therapy (M 3.8±1.03; Me 4) and performing nursing techniques (M 3.7±0.95; Me 4). The most complex activities were considered to be confronting an emergency situation (M 3.8±1.03) and the planning of care for a group of patients (M 3.3±0.941), and these two activities had had the least amount of supervision.

CONCLUSIONS

A tutoring model emerged that was centred on learning by experience and with guidance.

Supervising medication administration by undergraduate nursing students: influencing factors

BACKGROUND

The administration of medication is an important skill nursing students need to learn in the clinical setting to develop safe practices. Legally within Queensland, registered nurses are required to provide personal supervision for this process. Research undertaken by the authors suggests the supervision students receive frequently falls short of what is legally required.

AIMS AND OBJECTIVES

The aim of the study was to examine the factors that influence the experiences of final-year undergraduate nursing students when administering medications in the clinical setting.

DESIGN

A grounded theory approach was used with constant comparative analysis to identify categories from the data.

METHODS

The experiences of final-year nursing students were explored using a grounded theory approach. In-depth, semi-structured interviews were conducted with 28 final-year undergraduate nursing students in Queensland, Australia.

RESULTS

Supervision was found to be the central issue influencing medication administration for students. Three main factors were identified as influencing the supervision provided by registered nurses: attitudes of the registered nurse, communication from the university, and busyness and having time.

CONCLUSIONS

The extent to which registered nurses provide direct supervision to nursing students when administering medication is influenced by factors inherent within the clinical environment.

RELEVANCE TO CLINICAL PRACTICE

The factors influencing the supervision provided by registered nurses needs further exploration that effective strategies can be implemented to ensure safe practices in relation to medication administration can be implemented.

Teaching during clinical practice: strategies and techniques used by preceptors in nursing education

The preceptor is a nurse who teaches and supports the student and is seen as pivotal to student learning within the clinical setting. Earlier studies have shown that preceptors' pedagogical competence is significant for facilitating learning during clinical practice. However, studies describing pedagogical competence, especially in terms of teaching strategies, seem to be scarce. The aim of this study was to describe which strategies and techniques preceptors use to teach undergraduate nursing students during clinical practice. The study had an ethnographic approach; methods used were participant observations and focus group interviews with nurses who were experienced in precepting undergraduate nursing students. Findings illustrated how preceptors used different strategies and techniques in a continuous process of adjusting, performing and evaluating precepting. Increased knowledge on how the preceptors actually teach student nurses during clinical practice will help facilitate educational programmes for preceptors, which will enhance their pedagogical skills and competences.

Clinical supervision: The way forward? A review of the literature

A discussion of clinical supervision to enhance existing support structures such as preceptorship and mentorship to positively influence the recruitment and retention of newly graduate nurses provides the main focus for this paper. The nursing literature provides evidence for alternative but equally worthy perspectives on clinical supervision. Essential to the successful practice of clinical supervision is the need to ascertain whether it is simply a system to ensure an effective workforce or one that will empower nurses to realise their vision of nursing.