The ongoing search for best practice in clinical teaching and learning: A model of nursing students’ evolution to proficient novice registered nurses

'Working as a Real Nurse': Nursing Students' Experiences of a Clinical Education Ward in Psychiatric Care

Although the concept of clinical education wards has shown encouraging outcomes regarding nursing students' satisfaction with clinical placements in somatic care, the existing research in a psychiatric context is sparse. This study aims to explore nursing students' experience during clinical education at a psychiatric clinical education ward. A qualitive descriptive study with content analysis, using interviews with 16 bachelor's degree nursing students was conducted. The results indicated that an enriched and adapted learning environment focusing on psychiatric nursing with peer learning supported independence and progression into the future nursing role.

Becoming a nurse preceptor, the challenges and rewards of novice registered nurses in high acuity hospital environments

Precepting is a common and expected role of nurses in clinical settings worldwide. This research explored novice nurse's experiences of precepting undergraduate nursing students in high-acuity hospital environments. An interpretive study was undertaken with 12 novice nurses (<3-years of post-registration clinical experience), who were precepting nursing students. Data was collected through focus groups and thematically analysed. The zone of proximal development theory was applied to understand the relationship of learning that occurs between students and nurses. Three themes were identified. Firstly, participants established that precepting students enhanced their own self-development, and was a rewarding role, that not only developed the student into a nurse, but provided opportunities for the novice nurse to learn. Second, precepting was both challenging and rewarding. The challenges involved the student, the context, and the preceptors' own teaching and learning skills, resulting in feelings of frustration and conflict between nursing care and preceptor roles. Third, precepting was an expectation of both the nursing role and from senior nurses. At times, the participants felt overwhelmed and drained, particularly when having students that challenged them on multiple consecutive shifts. Participants identified the need for guidance and support from more capable peers to develop confidence while precepting nursing students.

The learning space-interpersonal interactions between nursing students, patients, and supervisors at developing and learning care units

Purpose: Previous research shows that the learning space is significant for students’ learning in pairs in clinical practice but does not explain the meaning of the phenomenon. The aim of this study is thus to explain and understand the learning space that occurs in the interaction between the patients, the pairs of nursing students, and the supervisors on a developing and learning care unit in Sweden. Method: The study has been carried out with a Reflective Lifeworld Research (RLR) approach founded on hermeneutics. A total of 39 informants, consisting of 16 patients, five pairs of students (10 students), and 13 supervisors, were observed and interviewed. Results: The results reveal that an interpersonal linkage between the patients, the students, and the supervisors is created within the learning space. A learning space, based on respect towards each other, creates the prerequisite for beneficial and supportive interactions that contribute to a deeper relationship. Conclusion: The phenomenon is complex due to its expandable nature and due to the fact that the learning space cannot be isolated from the surrounding environment. In order to exploit the potential of the learning space it is of importance to understand and consider the learning space as a whole.

Learner : preceptor ratios for practice-based learning across health disciplines: a systematic review

CONTEXT

Practice-based learning is a cornerstone of developing clinical and professional competence in health disciplines. Practice-based learning systems have many interacting components, but a key facet is the number of learners per preceptor. Different learner : preceptor ratios may have unique benefits and pose unique challenges for participants. This is the first comprehensive systematic review of the topic. Our research questions were: What are the benefits and challenges of each learner : preceptor ratio in practice-based learning from the perspectives of the learners, preceptors, patients and stakeholder organisations (i.e. the placing and health care delivery organisations)? Are any ratios superior to others with respect to these characteristics and perspectives?

METHODS

Qualitative systematic review of published English-language literature since literature database inception, including multiple health disciplines.

RESULTS

Seventy-three articles were included in this review. Eight learner : preceptor ratio arrangements were identified involving nursing, physiotherapy, occupational therapy, pharmacy, dietetics, speech and language therapy, and medicine. Each arrangement offers unique benefits and challenges from the perspectives of learners, preceptors, programmes and health care delivery organisations. Patient perspectives were absent. Despite important advantages of each ratio for learners, preceptors and organisations, some of which may be profession specific, the 2 : 1 and 2+ : 2+ learner : preceptor ratios appear to be most likely to successfully balance the needs of all stakeholders.

CONCLUSIONS

Regardless of the learner : preceptor ratio chosen for its expected benefits, our results illuminate challenges that can be anticipated and managed. Patient perspectives should be incorporated into future studies of learner : preceptor ratios.

Undergraduate nursing students' perceptions of the effectiveness of clinical teaching behaviours in Malaysia: A cross-sectional, correlational survey

BACKGROUND

Clinical teachers are a critical determinant of the quality of nursing students' clinical learning experiences. Understanding students' perceptions of clinical teachers' behaviours can provide the basis for recommendations that will help improve the quality of clinical education in clinical settings by developing better clinical teachers.

OBJECTIVES

To understand clinical teaching behaviours and their influence on students' learning from the perspective of undergraduate nursing students.

DESIGN

A cross-sectional, correlational survey.

SETTING

A nursing faculty in Kuantan, Pahang, Malaysia.

PARTICIPANTS

A sample of 120/154 (78%) students from Year 2-Year 4 were recruited according to set criteria.

METHODS

A self-administered questionnaire was employed to collect demographic data, and students' perceptions of clinical teaching behaviours and their impact on learning using the Nursing Clinical Teaching Effectiveness Inventory (NCTEI).

RESULTS

Year 3 and 4 students perceived faculty clinical teaching behaviours positively. There was a significant association between clinical teaching behaviours and their influence on students' clinical learning. Teachers' competence rated as the most significant influential factor, while teachers' personality rated as least influential.

CONCLUSION

Participants were able to identify the attributes of good clinical teachers and which attributes had the most influence on their learning. Overall, they perceived their teachers as providing good clinical teaching resulting in good clinical learning. Novice clinical teachers and nursing students can use this positive association between teaching behaviours and quality of clinical learning as a guide to clinical teaching and learning.

Nurses' experiences working with nursing students in a hospital: a phenomenological enquiry

Objective:

this paper explores the experiences of registered nurses working with Spanish nursing students within the hospital.

Methods:

a qualitative phenomenological approach was followed. Purposeful sampling was employed. Twenty-one registered nurses, from a public hospital located in Spain, were included in the study. Data were collected by means of unstructured and semi-structured interviews and were analysed using Giorgi's proposal. The Consolidated Criteria for Reporting Qualitative Research were followed.

Results:

three main themes described the experience of registered nurses: "The nurse's relationship with nursing students"; most nurses emphasized the importance of the first contact with students and they considered students' attitude to be key. "Defining the role of the student in clinical practice"; it is necessary to unify the nurse's role and interventions to avoid misleading students and establish priorities in clinical practice. "Building bridges between clinical settings and the University"; the need to establish a common ground and connection between the university and hospital clinical settings was emphasized. Nurses felt that the training program should also be designed by the clinical settings themselves.

Conclusions:

understanding the meaning of nursing students with registered nurses might gain a deeper insight into their expectations.

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.

Evaluation of student nurses' perception of preparedness for oral medication administration in clinical practice: a collaborative study

BACKGROUND

Attainment of oral medication administration skills and competency for student nurses is challenging and medication errors are common. The ability of nurses to master a clinical skill is dependent upon educational instruction and practice.

OBJECTIVES

The aim of this study was to evaluate nursing students' perception of preparedness for oral medication administration in two practice environments and determine possible relationship between student demographics and their perceived preparedness for oral medication administration.

DESIGN

This was a cross sectional, exploratory study.

PARTICIPANTS

Eighty-eight second year students from a baccalaureate nursing course from two metropolitan Australian tertiary institutions participated.

METHODS

Student nurses' perception of preparedness for oral medication administration was measured via a self-administered, adapted, and validated questionnaire.

RESULTS

The overall mean Total Preparedness Score was 86.2 (range 71-102). There was no significant difference for perceived total preparedness to administer oral medications between the two facilities. Whilst there was no significant relationship established between student demographics and their perceived preparedness to administer oral medications, four single questions related to clinical practice were shown to be significant.

CONCLUSION

Low fidelity simulated teaching environments that incorporate time management and post medication situations, may improve student nurses' perceived preparedness for oral medication administration.

The development of a model of education for casual academic staff who support nursing students in practice

Nursing is predominantly a practice based profession where clinical placement for pre-registration nursing students is a significant component of their programme, as this is pivotal in achieving work readiness of the graduate registered nurse. It is therefore important to ensure nursing students have high quality clinical placements that are supervised by well-prepared experienced registered nurses. This paper discusses one component of the reconnaissance phase of a wider action research project being undertaken in a metropolitan university in NSW, Australia seeking to enhance the development and support of casual academic staff known as clinical supervisors who support students in clinical placement. The outcomes attributed to this project are the development of a participation model which has resulted in a collaborative partnership between the university and clinical supervisors and secondly, the embedding of solution focused ways of working and practice development into the program. The information from the reconnaissance phase of this project confirms the need for further research into the implementation of the participatory model to ensure that future education and support process are developed through collaboration.

Promoting student learning and increasing organizational capacity to host students in residential aged care: a mixed method research study

BACKGROUND

In Australia, the Federal government's agenda to increase clinical training places to address the forecast shortfall of nurses is driving innovation in clinical education. A student leadership model of clinical education, named the Student Nurse Led Ward model, was designed for the aged care context to provide a high number of clinical placements for pre-service Bachelor of Nursing students in an under-utilized clinical education setting.

OBJECTIVES

The research aimed to determine the viability of the innovation by (1) developing a preliminary understanding of what students were learning and (2) exploring stakeholders' perceptions about student learning.

DESIGN

A mixed methods design included an ageing knowledge test and ageing attitudes survey, both administered before and after the placement, student narratives of a learning event written after the placement, as well as focus group and individual interviews with stakeholders.

SETTING

Three residential aged care facilities partnering with one university in one Australian jurisdiction.

PARTICIPANTS

Included 35 of the 45 students who began placement in the aged care facilities during one semester, a convenience sample of 15 staff and each of the managers and educators from the three agencies.

METHODS

Descriptive statistical analysis of student pre-post knowledge test and attitude survey, hermeneutic analysis of student narratives, and content analysis of individual and group interview data.

RESULTS

There was an increase in student knowledge around sensory changes, delirium, and drug reactions in older people. There was a slight increase in students' expression of ageist attitudes following the clinical experience. The clinical educator position was considered to be critical to the success of the model.

CONCLUSIONS

This Student Nurse Led Ward model is a viable model to increase clinical placements, with preliminary evidence in this study suggesting that students benefit through increased knowledge, understanding and capacity to work with older people.

Clinical facilitator learning and development needs: exploring the why, what and how

This study explores the practice experiences of clinical facilitators providing a voice for nurses undertaking the role, a group who up until now has been silent. Seven clinical facilitators from acute care areas within Tasmania participated in the interpretive and participatory study. Three core aspects of clinical facilitation identified were the why, what and how of facilitation. The study identified why nurses became clinical facilitators, what their experiences involved - both positive and negative; and enabled exploration as to how the role could be better supported in the future, through addressing ongoing professional development learning needs. Results of this study have provided in depth insight into the world of the clinical facilitator. The importance of key strategies to implement ongoing professional development through mentorship, provision of feedback and the development of communities of practice are seen as imperative to ensure the role of clinical facilitator reaches its full potential to bridge the gap between theory and practice experienced by undergraduates during clinical placements. Such strategies will help ensure quality clinical placements for undergraduate nursing students.

Guidelines for value-sensitive clinical accompaniment in community health nursing

AIM

The goal of the first part of the study was to explore and describe the experiences of students with regard to value-sensitive clinical accompaniment in community nursing. The purpose of phase two of the research and of this article was to develop guidelines for value-sensitive clinical accompaniment of student nurses by professional nurses in community nursing

BACKGROUND

Undergraduate students have reported that owing to different cultures and values, value conflicts are experienced during clinical accompaniment, which affects clinical learning in community nursing negatively.

METHOD

A qualitative, exploratory and descriptive research design was done in a specific context; guidelines were formulated as a result of the findings in phase 1. Once the guidelines were formulated the guidelines were validated and refined by presenting them to a panel of experts for validation. The accessible population was experts in the field of community health nursing and the participants that were conveniently selected were asked to validate the guidelines.

RESULTS

Three main categories were identified, namely, respect during clinical accompaniment, value-sensitive communication and sensitivity to quality of clinical accompaniment. The validated and refined guidelines were described. CONCLUSION AND IMPLICATIONS FOR NURSE MANAGERS: Guidelines for value-sensitive clinical accompaniment of student nurses by professional nurses as experts in community nursing should be implemented by nurse managers as they are important in any relationship to set the climate for both personal and professional wellbeing.

International nursing students and what impacts their clinical learning: literature review

This paper reviews the sparse literature about international nursing students' clinical learning experiences, and also draws on the literature about international higher education students' learning experiences across disciplines as well as nursing students' experiences when undertaking international clinical placements. The paper aims to identify factors that may impact international nursing students' clinical learning with a view to initiating further research into these students' attributes and how to work with these to enhance the students' clinical learning. Issues commonly cited as affecting international students are socialisation, communication, culture, relationships, and unmet expectations and aspirations. International student attributes tend to be included by implication rather than as part of the literature's focus. The review concludes that recognition and valuing of international nursing students' attributes in academic and clinical contexts are needed to facilitate effective strategies to support their clinical practice in new environments.

Development and psychometric testing of the Ascent to Competence Scale

AIM

This paper reports the development and psychometric testing of the Ascent to Competence Scale, an instrument designed to measure nursing students' perceptions of the quality of their clinical placement experience.

BACKGROUND

The key purpose of clinical placements is to facilitate students' learning and progress toward the attainment of competence. The attainment of competence requires personal commitment and active involvement of students; support and guidance of clinical and academic staff; and clinical environments that are welcoming and inclusive of students.

METHOD

The items for the Ascent to Competence Scale were identified following a critical review of the literature. Content and face validity were established by an expert panel. During 2010 the instrument was tested with third year nursing students (n=88) from one Australian university. Exploratory factor analysis with promax oblique rotation was used to determine construct validity and Cronbach's coefficient alpha determined the scale's internal consistency reliability.

RESULTS

The final scale demonstrated satisfactory internal consistency (alpha 0.98). Exploratory factor analysis yielded a three-component structure termed "Being welcomed"; "Belongingness" and "Learning and competence". Each subscale demonstrated high internal consistency: 0.89; 0.96; and 0.95 respectively.

CONCLUSION

The Ascent to Competence Scale provides a fresh perspective on clinical placements as it allows for the relationship between belongingness, learning and competence to be explored. The scale was reliable and valid for this cohort. Further research in different contexts would be valuable in extending upon this work.

RELEVANCE TO CLINICAL PRACTICE

The Ascent to Competence Scale profiled in this paper will be of benefit to both educational and healthcare institutions. The use of a quantified yardstick, such as the Ascent to Competence Scale, is important in evaluating the efficacy of programs, placements and partnerships between higher education and health services.

Nurse residency programs: an evidence-based review of theory, process, and outcomes

Nursing shortages exist worldwide while job stress, dissatisfaction, lack of peer support and limited professional opportunities still contribute to attrition. The aim of this systematic review is to describe and evaluate the quality of the science, report recommendations and lessons learned about implementing and evaluating nurse residency programs (NRPs) designed to improve new graduate transitioning. Databases were searched between 1980 and 2010 using five search terms: nurse, intern, extern, transition and residency programs. Twenty studies reporting programs for new RNs fit the inclusion criteria. Three major discoveries include: 1. Wide variation in content, teaching and learning strategies make comparison across programs difficult; 2. Lack of theory in designing the educational intervention has limited the selection and development of new instruments to measure program effectiveness; and 3. Well designed quasi-experimental studies are needed. As a major nursing education redesign, NRPs could be used to test the principles, concepts and strategies of organizational transformation and experiential-interactive learning theory. By focusing on fiscal outcomes, current administrators of NRPs are missing the opportunity to implement an organizational strategy that could improve workplace environments. Healthcare organizations need to envision NRPs as a demonstration of positive clinical learning environments that can enhance intra- and interprofessional education and practice.

An interprofessional Web-based resource for health professions preceptors

OBJECTIVE

To develop a Web-based preceptor education resource for healthcare professionals and evaluate its usefulness.

METHODS

Using an open source platform, 8 online modules called "E-tips for Practice Education" (E-tips) were developed that focused on topics identified relevant across healthcare disciplines. A cross-sectional survey design was used to evaluate the online resource. Ninety preceptors from 10 health disciplines affiliated with the University of British Columbia evaluated the E-tips.

RESULTS

The modules were well received by preceptors, with all participants indicating that they would recommend these modules to their colleagues, over 80% indicating the modules were very to extremely applicable, and over 60% indicating that E-tips had increased their confidence in their ability to teach.

CONCLUSION

Participants reported E-tips to be highly applicable to their teaching role as preceptors. Given their multidisciplinary focus, these modules address a shared language and ideas about clinical teaching among those working in multi-disciplinary settings.

The clinical seminar as a learning methodology: an evaluation of nursing students' views

OBJECTIVE: To explore students' assessments of the clinical seminar as a complementary teaching method to the clinical practicum experience. METHODS: This was a qualitative study based on the hermeneutic phenomenology of Gadamer. Twenty-three open-ended interviews were conducted from among the 132 first-year students who attended an initial clinical practicum. We performed a qualitative analysis of the data using ATLAS.ti software. RESULTS: The students agreed that the clinical seminar gave them the opportunity to learn about procedures, nursing care and interpersonal relationships. They also found it very helpful when they encountered challenging stressful situations as they performed their practice, and believed it allowed them to make a connection between the theory in the classroom and the clinical practice. CONCLUSIONS: These seminars can contribute to reducing levels of stress during clinical practice. They can also help students obtain significant learning from their fellows and reduce the theory-practice gap.

Iranian staff nurses' attitudes toward nursing students

INTRODUCTION

Clinical education is an indispensible part of the nursing education. Clinical nurses play an important role in this teaching learning process. The quality and quantity of student-nurse interactions in the clinical area can either facilitate or hamper students' learning. The rationale of this research was to probe into staff nurses' attitudes toward nursing students within the context of clinical education in Iran. The nursing literature seems wanting in issues related to staff nurses' attitudes toward nursing students. Thus, we draw on Peplau's interpersonal relations in nursing to address staff-student relationship. That is, the nursing student was taken as the client.

METHODS

A descriptive cross-sectional design was selected for this study. The entire staff nurses of Medical and Surgical units (n=82) employed at Dr Fatemi and Imam Khomeini hospitals of Ardabil medical sciences university were selected. Stagg's questionnaire and a demographic tool were used to gather data. Attitudes were measured using a five-point Likert scale. Attitudes of staff nurses were inspected using cross tabulations and frequencies.

FINDINGS

The results demonstrated that attitude scores toward nursing students were low and moderate. Some nurses (45.71%) believed that working with students is pleasant and most (98.57%) have thought that staff should have a good relationship with nursing students. Furthermore, staff nurses pointed out that the there is a need to overhaul the educational system of nursing students (94.3%), that nursing students do not acquire the sufficient clinical skill (67.14%), and that the students are not prepared enough for the clinical task (51.43%).

CONCLUSION

According to the results of the staffs' feelings on the relationship between nurse and student, it seems that nurses should cultivate an atmosphere which ends to empathy, assurance and sincerity of nursing students.