Student nurses’ experiences of community-based practice placement learning: A qualitative exploration

Comparative study of the undergraduate community-based nursing curriculum in Shahid Beheshti university of medical sciences, school of nursing and linfield school of nursing

BACKGROUND

Revising UCBNC using successful education systems in the world to guarantee the quality of the curriculum is necessary. This study aimed to compare the undergraduate community-based nursing curriculum at Shahid Beheshti University of Medical Sciences, School of Nursing, and Linfield School of Nursing.

MATERIALS AND METHODS

The present comparative descriptive study was conducted using Beredy's four-step approach (description, interpretation, juxtaposition, and comparison) in 2022 and searched the required data using keywords. The fundamental elements of the community-based nursing curriculum were collected and analyzed from the website and internal and external databases.

RESULTS

The findings of this study showed that there are main differences in the curriculum of the two schools. All dimensions of the Linfield School of Nursing curriculum are designed based on the community-based nursing education model focusing on communication, community, cultural diversity, health, social justice, stakeholder engagement, evidence-based practice, and responding to community needs. Still, the attention and emphasis on the mentioned items in Iran's curriculum are fragile.

CONCLUSIONS

The nursing curriculum in Iran should be revised based on the community-based nursing education model, and according to the local conditions, background, and community needs so that can be achieved to the maximum productivity and efficiency of nurses using meet the community needs.

Explaining of existing challenges of community-based undergraduate nursing education in Iran: a qualitative study

BACKGROUND

The education of nursing students should be such that the health needs of the community are met, but in Iran, due to some problems, students do not receive such education. Therefore, the present study was conducted to explain the existing challenges of community-based undergraduate nursing education in Iran.

METHODS

Ten individual semi-structured interviews were conducted with the faculty members and nursing specialists in this qualitative study. Eight focus group interviews were conducted to the nurses and nursing students using a purpose-based sampling method in 2022. The interviews were recorded and transcribed and then content analysis was done by the Lundman and Granheim method.

RESULTS

Five themes were obtained from the analysis of participants' responses, which include "weakness in community-based nursing education and curriculum", "treatment-oriented health system and education", "defect in the infrastructure and basic structures of community-based nursing education", "weakness in the implementation of community-based nursing education" and "weakness in the stakeholder engagement and cooperation of interested organizations".

CONCLUSION

Interviews with the participants provided a vision of the challenges of community-based nursing education so that the reviewers of the undergraduate nursing curriculum in the ministry and nursing schools, educators, policymakers and nursing managers can use the results of the present study to improve the quality of education and the effective use of nursing students in responding to the community's needs and provide a proper context for improving students' learning.

Community of inquiry Framework Combined With Podcast Media in Nursing Education innovation During Covid-19 Pandemic: An Evaluative Study

Background

The COVID-19 pandemic has not researched inquiry methods much, other than that it has never been combined with podcast media to better refine students' abilities. The purpose of this study was to determine student satisfaction with basic nursing theory and practice courses taught using the Community of Inquiry framework using podcast media.

Methods

This evaluation was done at a university using a validated Community of Inquiry survey (n = 54) and interviews (n = 20). A convenience sample of 54 graduate students enrolled in a core research field comprised the study participants. The quantitative data were analyzed descriptively and the qualitative data were thematically coded.

Results

Five major themes emerged: It was a new experience, and fun to learn; it is challenging to learn; it is an ongoing enthusiasm; it is well known, and useful to others. Overall, student satisfaction was high, especially in the cognitive presence (critical thinking) and instructor presence (mostly related to pedagogy) categories. Student perspectives on developing "social presence" vary, but the framework is generally effective for stimulating inquiry and fostering a sense of community. Students can gain thorough knowledge of the learning goals they wish to pursue.

Conclusion

Formation of an "investigation community" through the use of the media of podcasts. This framework has significant potential for use in the teaching of nursing research subjects; satisfaction is high when students report learning not only theory and practice, but also how to "make" character changes through the formation of professional and intellectual communities.

The presence of missed care: a staff development response

AIMS

This study quantifies the types and frequencies of missed care identified by nurses and measures its impact on their capacity to demonstrate mandatory practice standards as future hospital staff.

BACKGROUND

Considerable literature exists as to the nature of missed care but there is a paucity of findings about how missed care impacts on learning firstly as a student and then as a graduate nurse employed in a hospital setting. Additionally, there is little emphasis as to how staff development for nurses exposed to missed care may be implemented METHODS: A non-experimental research design using self-audit data was selected to collect information about the types and frequencies of missed care from nurses engaging in clinical experience. A convenience sample of 471 nursing students completing their undergraduate nursing degree program. A multi-variate statistical approach was used to apply and then model the consensus scores of undergraduate nurses' beliefs about the frequency of missed care. Implications for their developing competence in critical thinking, therapeutic communication and maintaining capacity for professional practice has been considered.

RESULTS

Eight variables directly affect student's total scores underpinning their understanding of missed care and their ability to meet professional standards of practice, given their exposure to care omission. These factors reflect differing nurse attributes, the nature of the clinical venues and shift times, preceptor type, student satisfaction with work teams and staffing adequacy.

CONCLUSIONS

Modeling outcomes suggest possible changes to hospital staff development learning program content, learning processes and how it may be better delivered through to minimise episodes of missed care.

Effect of community-based education on undergraduate nursing students' skills: a systematic review

Background

Community-based education, as an effective approach to strengthen nurses’ skills in response to society’s problems and needs has increased in nursing education programs. The aim of this study was to review the effect of community-based education on nursing students’ skills.

Methods

For this systematic review, ProQuest, EMBASE, Scopus, PubMed/ MEDLINE, Cochran Library, Web of Science, CINAHL and Google Scholar were searched up to February 2021. The methodological quality of the studies was assessed using the Mixed Methods Appraisal Tool (MMAT). Seventeen studies were included in this systematic review. Inclusion criteria included articles published in English and were original articles.

Results

In all studies, undergraduate nursing students’ skills were improved by participation in a community-based education program. Community-based education enhances professional skills, communication skills, self-confidence, knowledge and awareness, and critical thinking skills and teamwork skills in undergraduate nursing students.

Conclusions

Community-based education should be used as an effective and practical method of training capable nurses to meet the changing needs of society, to improve nurses ‘skills and empower them to address problems in society.

Undergraduate student nurses' experiences of their community placements

BACKGROUND

Community nursing placements play an increasingly important part in the undergraduate nursing students learning experience as a greater proportion of health care delivery is set to migrate to community care settings. Therefore, nursing education programmes and health services must ensure that student nurses are exposed to high quality community placements that provide suitable learning experiences for students to acquire the skills and knowledge required for the health service of the future.

OBJECTIVES

This qualitative evidence synthesis examines undergraduate nursing students' experiences of community nursing placements from 1996 to date.

DESIGN

Qualitative Evidence Synthesis, Thematic synthesis.

DATA SOURCES

CINHAL, EMBASE, ProQuest, Medline, Embase, Scopus, Psycinfo.

REVIEW METHODS

A systematic search across electronic databases was carried out to identify all available existing evidence relevant to the search question. Data was extracted and synthesised through thematic synthesis to identify and interpret emerging themes.

RESULTS

Six qualitative studies were included in the data, from these three themes were identified. The first of these highlighted the important influence of the community nursing teams and mentor on the students' placement experience. The second theme highlights the students' professional development as a result of their community placements and finally the third theme explores the students' perceptions of the essence of caring in the community.

CONCLUSION

The community provides valuable learning experiences of nursing from an alternative perspective, enhancing professional development and understanding of the nurse patient relationship. Mentorship and inclusion in teams are key factors that influence students' experiences and this working environment is useful for teaching about holistic care that is person and family centered. Role modeling is enhanced by the pace and proximity of the mentoring relationship.

Peer learning and collaborative placement models in health care: a systematic review and qualitative synthesis of the literature

AIMS

To summarise the international empirical literature to provide a comprehensive overview of peer learning and collaborative practice placement models in health care and to synthesise their benefits and challenges.

BACKGROUND

Practical placements for students are in high demand due to the need for an increased nursing, midwifery and health professional workforce, thus collaborative placement models are an attractive solution to potentially increase placement capacity and enhance the student learning experience.

DESIGN

A systematic search of the literature and qualitative data synthesis using the PRISMA checklist and ENTREQ guidelines.

REVIEW METHODS

MEDLINE and CINAHL searched in March 2020. Quality appraisal of studies conducted. Collaborative models and empirical findings summarised. Reported benefits, challenges and implementation recommendations synthesised. Two tables developed for data representation.

RESULTS

172 studies were identified by the search strategy. Of these, 47 articles were included for appraisal and synthesis. 30 articles employed qualitative, seven quantitative and ten mixed-methods approaches. Research took place in eight countries. The majority of studies employed focus groups, interviews as well as questionnaire design. The total participant sample was 3462 consisting of students and educators.

CONCLUSIONS

This review confirmed that any peer learning is beneficial in supporting students' confidence and team working skills. It is especially helpful when pairing first year with third-year students. The latter can demonstrate their clinical skills and prepare for working in practice. Simultaneously, expert-led learning is important for role modelling and for the recognition of acquired skills. Evidence on the optimal placement experience is inconclusive; however, it can be concluded that any form of collaborative placement model requires careful planning and continuous preparation for staff and students.

RELEVANCE TO CLINICAL PRACTICE

Decision makers should consider implementing at least some form of peer learning to assist students with peer support, and ideally work towards a collaborative learning environment.

Psychometric properties of the clinical learning environment, Supervision and Nurse Teacher scale (CLES+T) for undergraduate nursing students in Hong Kong

The Clinical Learning Environment, Supervision and Nurse Teacher Evaluation Scale is useful for understanding students' perceptions towards clinical placement and for measuring the quality of clinical education. Validated versions of the scale are only available for Western countries. Therefore, this study aimed to establish the validity and reliability of the Clinical Learning Environment, Supervision and Nurse Teacher evaluation scale for undergraduate nursing students in Hong Kong. Six experts including clinical mentors, clinical teachers, advanced practice nurse and nursing students participated in phase 1. Fifteen nursing students participated in phase 2 and 178 nursing students participated in phase 3 of this study during January 2017 to June 2017. The Scale-Content Validity Index was 0.93 and the Item-Content Validity indexes ranged from 0.83 to 1. Exploratory factor analysis indicated a 6-factor solution (i.e. "supervisory relationship", "role of nurse teacher", "leadership style of ward manager", "premises of nursing on the ward appreciated", "interaction with staff" and "learning atmosphere"). The internal consistency was good (Cronbach's alpha = 0.94) and test-retest reliability over a 2-week interval was satisfactory (Pearson's coefficient = 0.85). The Clinical Learning Environment, Supervision and Nurse Teacher evaluation scale showed acceptable psychometric properties for use as an evaluation scale in Hong Kong.

How nursing students' placement preferences and perceptions of community care develop in a more 'community-oriented' curriculum: a longitudinal cohort study

BACKGROUND

Extramuralisation in healthcare has influenced medical and nursing curricula internationally with the incorporation of themes related to primary/ community care. Despite this, students do not easily change their career preferences. The hospital is still favourite, leading to labour market shortages in extramural care. This study investigates how baccalaureate nursing students' perceptions of community care and placement preferences develop over time in a more 'community-care-oriented' curriculum, to gain insights on which curriculum elements potentially influence career choices.

METHODS

A nursing student cohort of a University of Applied Sciences in the Netherlands (n = 273) underwent a new four-year curriculum containing extended elements of community care. The primary outcome was assessed with the Scale on Community Care Perceptions (SCOPE). Data were collected each year of study. Descriptive statistics were used to investigate students' placement preferences and perceptions, and linear mixed model techniques (LMMs) for measuring how students' perceptions develop over time. Patterns of placement preferences at individual level were visualised.

RESULTS

Students' perceptions of community care, as measured with SCOPE, show a slight decrease between year 1 and 4, while items mutually differ substantially. In contrast, the preference of community care for a placement increases from 2.6% in year 1 tot 8.2% in year 4. The hospital is favourite in year 1 (79.8%), and remains most popular. At individual level, students often change placement preferences, although a preference for the hospital is more consistent. The LMMs indicates that, at the four time-points, the estimated marginal means of students' perceptions fluctuate between 6 and 7 (range 1-10). A placement in community care did not positively influence students' perceptions, and an intensive 1 week theoretical programme was only temporarily influential.

CONCLUSIONS

Although interest for placement in community care increased substantially, it was not clear which curriculum elements stimulated this, nor did the curriculum positively influence students' perceptions. As most students do not look forward to the high responsibility of the field, other curricula with educational tracks for more mature students/ nurses with a vocational training may be an alternative contribution to solving the labour market problems in community care.

Supplementing Clinical Practice in Nursing Homes With Simulation Training: A Qualitative Study of Nursing Students' Experiences

INTRODUCTION

Limited access to nurse supervisors, insufficient learning support and staff with high workloads are well documented in the research literature as barriers to nursing students´ learning in clinical practice in nursing homes. Due to these barriers nursing students may benefit from additional learning support from nurse educators during their clinical practice period.

OBJECTIVE

The study aimed to explore nursing students' experiences of supplementary simulation training as a tool to support learning during clinical practice in nursing homes.

METHODS

A descriptive qualitative design was used. Twenty-seven first-year nursing students from a university college in Norway were interviewed after attending a seven-week practice period in nursing homes with supplementary simulation training. Three semi-structured focus group interviews were audio recorded, transcribed, and analysed using systematic text condensation.

FINDINGS

Three categories of student experiences were identified: enhancing the reasoning behind care, transferring knowledge and experiences between the learning environments and enhancing the sense of mastery.

CONCLUSION

The supplementary simulation training seemed to complement clinical practice by consolidating the students' learning during the clinical practice period, enhance the students' motivation and sense of mastery, and consequently their efforts to seek out new challenges, explore and learn both in the clinical and the simulated environment.

Student nurses' career intentions following placements in general practice through the advanced training practices scheme (ATPS): findings from an online survey

BACKGROUND

The demand for General Practice services in the UK, and elsewhere, is rising quickly. In part, the increasing demand is from an aging population that requires management of multiple long-term conditions. The General Practice Nurse is increasingly taking on the role. It is acknowledged that if general practice is to be able to recruit sufficient General Practice Nurses (GPNs) to meet this increasing demand in the future, new graduate nurses must be encouraged to consider general practice as a viable career option. This research is part of a review of the Advanced Training Practice Scheme (ATPS) which supported clinical placements in participating general practices.

METHODS

The aim of the study was to examine nursing students' perceptions of GP placements, and their effect upon career intentions following graduation from Sheffield Hallam University (SHU), in the UK. Interviews and an online survey were used collect data. Only the survey is reported here. The bespoke survey examined students' views of: opportunities for learning new clinical skills and consolidating existing clinical skills; the learning environment in general practice and their views on a career in general practice.

RESULTS

One thousand one hundred twenty undergraduate adult-field nursing students were contacted, with a response rate of 41% (N = 462). Ninety respondents had a placement and, 92% (N = 84) viewed practice nursing positively, and 77% (N = 70) felt that the placement had transformed their views on general practice. The opportunity to participate in the management of the various aspects of chronic disease was identified by 84% (N = 76) of the students as a key new skill they had acquired. They also reported that they valued a team ethos, control over aspects of work, and the variety of health problems they encountered.

CONCLUSION

The findings from this study demonstrate a positive experience arising from the provision of General Practice placements for nursing students. The use of 'targeted' placement schemes with appropriate support such as this may be seen as a viable way of exposing nursing students to General Practice nursing, and of encouraging new graduate nurses to consider General Practice nursing as a viable career option.

The student experience of a 'kidney CAMP' as a primary care clinical placement for undergraduate nursing students

BACKGROUND

Historically clinical placements have been within acute care settings. In a more contemporary society, the future focus of health care is primary care, with an emphasis in expanding primary care clinical placements, to meet the needs of increasing workforce requirements. An innovative collaborative educational model was designed to provide a high quality learning experience and to increase numbers of students experiencing a primary care clinical placement.

OBJECTIVE

To explore student nurses' lived experiences within an innovative primary care setting.

METHODS

A qualitative case study was undertaken to analyse nursing students' experiences at the Kidney Kids Camp primary care clinical placement.

FINDINGS

Participants described how the primary care placement changed their view of nursing and the nurses' role. Five themes emerged from the research: developing knowing through children's eyes; entering the world of primary care; facing a journey of self-discovery; it's all in the way you communicate and; it makes you think differently about nursing.

DISCUSSION

The experience of this primary care placement enabled nursing students to enter the world of children living with chronic illness. Immersing students into this unique environment enabled them to gain a greater insight into primary care through the eyes of the children.

CONCLUSION

Kidney Kids camp experiences presented nursing students with an enhanced appreciation of primary care nursing, working with children, and an understanding of the impact of chronic health illnesses, through the primary care lens.

Building the English health visitor workforce as a result of the Health Visitor Implementation Plan 2011-2015: a survey study of career progression and retention for newly qualified health visitors

AIM

This study aimed to explore the extent to which health visitors who trained and qualified in both Greater London and the South West of England between September 2011 and January 2016 were employed in health visiting posts and have remained in the profession.

BACKGROUND

In 2011, the UK Government launched the Health Visitor Implementation Plan 'A Call to Action' (Department of Health, 2011) to develop the health visitor workforce by training 4200 health visitors over a four-year period. By April 2015, 4000 additional health visitors were trained, but the total workforce has since fallen back to pre-Implementation Plan size.

METHODS

Data were collected using a survey, completed online by participants. All participants had undertaken a health visitor education programme at one of two participating universities. The survey was distributed in January 2017 and completed by 180 individuals. Quantitative data were analysed using SPSS; association was assessed using individual chi-square tests or Fisher's exact test. Free-text responses were thematically analysed.

FINDINGS

Most (153; 87%) participants were still working as health visitors. Length of time spent working in the community prior to completing health visitor training was associated with staying in the role ( χ2 (with Fisher's exact test = 7.998, P = .027). Current pay was associated with attrition from the health visitor workforce ( χ2 (with Fisher's exact test) = 67.559, P < .001.). The majority who had left the health visitor role were on higher pay bands in their new post compared to those that had stayed (12; 60%). Bronfenbrenner's (1979) theory of socio-ecological development was used as a framework to interpret the results. While participants made an active choice to join the profession, leaving was influenced more by factors outside their control. To influence health visitor retention, both local and strategic changes are required.

Student perceptions of knowledge development and consolidation in a clinical community of practice

The undergraduate nursing degree in the UK comprises both theoretical and practical elements with the practical component being a large and important aspect. Within the clinical environment students learn to become a nurse by gaining membership of a community of practice and learning the technicalities of nursing. As the future of health and social care looks set to see unprecedented changes, contemporary nursing practice will demand that nurse graduates are equipped with advanced knowledge and skills. By doing so, graduate nurses will go on to provide high quality care within this changing context. The aim of the research was to explore student nurse perceptions of knowledge development and consolidation in a clinical practice environment by utilising a community of practice theoretical framework to question whether the clinical community of practice prepares student nurses for contemporary nursing practice. Four themes emerged from the research: establishing a place in the community, shaping identity, initiating learning opportunities, preparation for future practice. The findings suggest that the clinical community of practice provides an opportunity for students to both learn the technicalities of nursing and develop their professional identity. However, whilst the learning environment may be functional in maintaining current practice, it may not facilitate the learning required for contemporary nursing practice.

Influencing nursing students' perceptions of community care with curriculum-redesign; a quasi-experimental cohort study

BACKGROUND

The shift in healthcare to extramural leads to more patients with complex health problems receiving nursing care at home. However, the interest of baccalaureate nursing students for community nursing is moderate, which contributes to widespread labour-market shortages. This study investigates the effect of a more 'community-care-oriented' curriculum on nursing students' perceptions of community care.

METHODS

A quasi-experimental quantitative survey study with a historic control group (n = 477; study cohorts graduating in 2015, 2016, and 2017; response rate 90%) and an intervention group (n = 170; graduating in 2018; response rate 93%) was performed in nursing students of a University of Applied Sciences in a large city in the Netherlands. The intervention group underwent a new curriculum containing extended elements of community care. The primary outcome was assessed with the Scale on Community Care Perceptions (SCOPE). The control and intervention group were compared on demographics, placement preferences and perceptions with a chi-square or T-test. Multiple regression was used to investigate the effect of the curriculum-redesign on nursing students' perceptions of community care.

RESULTS

The comparison between the control and intervention group on students' perceptions of community care shows no significant differences (mean 6.18 vs 6.21 [range 1-10], respectively), nor does the curriculum-redesign have a positive effect on students' perceptions F (1,635) = .021, p = .884, R2 = < .001. The comparison on placement preferences also shows no significant differences and confirms the hospital's popularity (72.7% vs 76.5%, respectively) while community care is less often preferred (9.2% vs 8.2%, respectively). The demographics 'working in community care' and 'belonging to a church/religious group' appear to be significant predictors of more positive perceptions of community care.

CONCLUSIONS

Graduating students who experienced a more 'community-care-oriented' curriculum did not more often prefer community care placement, nor did their perceptions of community care change. Apparently, four years of education and placement experiences have only little impact and students' perceptions are relatively static. It would be worth a try to conduct a large-scale approach in combination with a carefully thought out strategy, based on and tying in with the language and culture of younger people.

When reach exceeds touch: Student experiences in a cross-sector community-based academic-practice partnership

OBJECTIVE

A partnership between three nursing programs, multiple high-needs public school districts and a local asthma coalition was developed as a way to build shared capacity aimed at improving health outcomes for children with asthma. This article explores student perceptions of their clinical experiences teaching asthma self-management within a regional cross-sector, community-based, multi-site academic-practice partnership.

DESIGN

Nursing faculty from three Long Island, New York-based nursing programs within the partnership jointly created a qualitative focus group methodology to more fully understand the phenomena of interest. A set of open-ended interview questions guided the sessions.

SAMPLE

Through purposive sampling, 42 undergraduate nursing students participated in 60-min focus group sessions.

MEASUREMENT

Focus group data were transcribed. Content analysis, coding, and theme development was carried out collaboratively. The unit of analysis was the individual participant responses informed by group interaction. A researcher diary was maintained.

RESULTS

One overarching theme and three sub-themes emerged from the data, reflecting student understandings in the areas of positioning, professional/personal identity, and social awareness. Ongoing analysis revealed patterns across the data sets linking student learning and the goals, milieu and workings of the partnership.

CONCLUSIONS

Findings suggest that the context of a thriving community-based academic-practice partnership, established to improve population health outcomes, offered unique clinical learning opportunities for students through exposure to the values, ideas, and innovation of the partnership itself.

Supporting student nurses who have their first clinical placement in the community nursing team

First year student nurses are increasingly undertaking their first placement with community nurses. The importance of how this initial learning experience is introduced by the higher education institution, as well as how the student is welcomed and integrated into the community nursing team, cannot be underestimated. Following positive anonymous feedback from students, which indicated that they had benefitted from the introduction, welcome and integration they experienced, the university and mentors reviewed how this had been done to identify good practice to share with colleagues. Students indicated that their welcome and integration had helped them to feel part of the team and enhanced learning, because they were so well supported, and mentors had facilitated learning experiences by acknowledging that this was their first placement experience. It is notable that mentors were committed to the students' learning and used workplace social capital to optimise the student experience. At a time when retention of students is essential to increase the future workforce, mentors dedicated to student learning are acting as ambassadors for the community workforce, and may well encourage students to have a career in community nursing.

Real-time simulation: first-hand experience of the challenges of community nursing for students

The Community Challenge is a simulated community event for pre-registration nursing students across all four fields. Through the provision of real-time simulation, the Community Challenge has combined a deeper learning for both nursing students and the drama students who were involved in making the scenarios real and interactive. The event was run over 5 days, with positive evaluations from students and staff. Furthermore, Community Challenge has been found to be successful in expanding opportunities for students that align with national drivers, curriculum planning and interprofessional learning. The event has allowed students to engage in learning with other fields, enhancing their own practice. The Community Challenge has been found to enhance the link between theory and practice within primary care, promoting the relevance and importance of community care within nursing.

Perceptions of community care and placement preferences in first-year nursing students: A multicentre, cross-sectional study

BACKGROUND

Despite increasing shortages of highly educated community nurses, far too few nursing students choose community care. This means that a strong societal problem is emerging that desperately needs resolution.

OBJECTIVES

To acquire a solid understanding of the causes for the low popularity of community care by exploring first-year baccalaureate nursing students' perceptions of community care, their placement preferences, and the assumptions underlying these preferences.

DESIGN

A quantitative cross-sectional design.

SETTINGS

Six universities of applied sciences in the Netherlands.

PARTICIPANTS

Nursing students in the first semester of their 4-year programme (n=1058).

METHODS

Data were collected in September-December 2014. The students completed the 'Scale on Community Care Perceptions' (SCOPE), consisting of demographic data and three subscales measuring the affective component of community care perception, perceptions of a placement and a profession in community care, and students' current placement preferences. Descriptive statistics were used.

RESULTS

For a practice placement, 71.2% of first-year students prefer the general hospital and 5.4% community care, whereas 23.4% opt for another healthcare area. Students consider opportunities for advancement and enjoyable relationships with patients as most important for choosing a placement. Community care is perceived as a 'low-status-field' with many elderly patients, where students expect to find little variety in caregiving and few opportunities for advancement. Students' perceptions of the field are at odds with things they believe to be important for their placement.

CONCLUSION

Due to misconceptions, students perceive community care as offering them few challenges. Strategies to positively influence students' perceptions of community nursing are urgently required to halt the dissonance between students' preference for the hospital and society's need for highly educated community nurses.

Feedback in the nonshifting context of the midwifery clinical education in Indonesia: A mixed methods study

BACKGROUND

Clinical education in some countries applies a hospital-based learning approach where each student rotates to one division to another division (call of shifting). However, for clinical midwifery education in Indonesia each student remains in a community midwifery clinic (call of nonshifting). Because of the differences in the shifting system used, the question of "How is feedback in the nonshifting context of the clinical midwifery education being given?" needs to be explored.

MATERIALS AND METHODS

This was a mixed methods study and was carried out in a School of Midwifery in Indonesia during 2014 and 2015. We explored the supervisors' and students' perception on the feedback delivery. Students' perceptions were collected through focus group discussions whereas supervisors' perceptions were recorded through interviews. The quality of feedback was observed using a checklist. Qualitative data were analyzed using Atlas Ti and quantitative data were analyzed using a descriptive statistic method.

RESULTS

From the qualitative data, students and supervisors perceived their feedback as "more intensive." They reported authenticity in the monitoring and feedback from the day-to-day delivery of patient care with their supervisors. Students and supervisors also described their feedback as "more integrated." The feedback process stimulated students to value history taking, physical examination, and midwifery care. On the other hand, quantitative data from observations presented that "intensive and integrated feedback" were not supported by the quality of the feedback based on literature of the theory of facilitating learning (the mean was 4.67 on a scale of 0-9).

CONCLUSIONS

The nonshifting clinical midwifery education can be a better alternative for facilitating the process of providing integrated and intensive feedback. To improve the quality of the feedback, training on providing feedback in a nonshifting context is fundamental in Indonesia.

Indicators of undergraduate nursing students' satisfaction with their learning journey: An integrative review

OBJECTIVES

In Australia Bachelor of Nursing programmes are delivered via both internal and distance modes yet there is little knowledge of the indicators of undergraduate nursing students' satisfaction with the learning journey. This integrative review was undertaken to uncover the indicators of undergraduate nursing students' satisfaction with their learning journey.

DESIGN

Integrative review. A review of key papers was undertaken. Only peer-reviewed papers published in scholarly journals from 2008 onwards were included in this integrative review.

DATA SOURCES

Pubmed, CINAHL, Google Scholar, Cochrane, Wiley Online and ProQuest Central databases were searched for relevant papers.

REVIEW METHODS

49 papers were appraised, by a minimum of two team members. CASP tools were used when evaluating qualitative research, systematic and integrated reviews while survey research was evaluated using a tool specifically developed for this purpose by the research team. All tools used to assess the quality of the research studies contained comprehensive checklists and questions relevant for the particular type of study. Data related to these checklists was extracted and the research team appraised the quality of each article based on its relevance to the topic, internal and external validity, appropriateness of data analysis technique(s), and whether ethical considerations were addressed. Seventeen papers were included in the final analysis. Data analysis involved a systematic approach using content analysis techniques.

RESULTS

This integrative review sought to identify indicators of nursing students' satisfaction with their learning journey. Authentic learning, motivation, resilience, support, and collaborative learning were identified by this integrative review as being key to nursing students' satisfaction with their learning journey. Sub themes were identified within each of these themes that assist in explaining nursing students' views of their learning journey.

CONCLUSION

The findings showed that higher satisfaction levels are attained when nursing students feel included and supported during their learning journey.

Mentoring students: exploring and managing incivil behaviour in community nursing placements

Students who demonstrate quiet incivility can be challenging and disrupt the learning that takes place in the community setting. Recognising incivility and acting to address this behaviour with students is difficult because the behaviour is not overt or obvious to others. The most important component in attempting to manage incivility is exploring the behaviour with the student to identify the potential cause, and negotiate a strategy to improve it. It is acknowledged that the behaviour may be due to personal, academic, or professional issues. If issues are not addressed, care activity and learning are affected, and this can result in failure to achieve in practice.

Undergraduate student nurses' lived experiences of anxiety during their first clinical practicum: A phenomenological study

BACKGROUND

The Fundamental Nursing clinical practicum is an essential module for nursing students. Some feel stress or anxiety about attending this first placement; however, evidence demonstrates that it is rare to explore the feelings of anxiety felt by the nursing students concerning their first clinical practicum.

OBJECTIVE

This study was designed to explore student nurses' experiences of anxiety felt regarding their initial clinical practicum while studying for their University degree.

DESIGN

A phenomenological approach was used.

SETTINGS

A university in Southern Taiwan.

PARTICIPANTS

A purposive sampling of fifteen student nurses with anxiety reactions who had completed their first clinical practicum.

METHODS

Data were collected using a semi-structured guide and deep interview. Data were analyzed using Colaizzi's seven-step phenomenological method.

RESULTS

Three themes surfaced in the findings. The first theme was anxiety around their first clinical practicum, which stirred up anxiety about: self-doubt, worry and fear; difficulty coping with the learning process; worry hampered establishing therapeutic relationships with patients; the progress of the patients' illness could not be predicted; and anxiety felt about lecturer-student interactions. The second theme was three phases of anxiety reactions, which included increasing anxiety before clinical practicum; exacerbated anxiety during clinical practicum, and relief of anxiety after clinical practicum. The third theme was coping behaviors. This comprised: self-reflection in preparation for clinical practicum; finding ways to release emotions; distractions from the anxiety; and, also facing their difficulties head-on.

CONCLUSION

The findings could help raise the awareness of lecturers and students by understanding student nurses' anxiety experiences and facilitating a healthy preparation for their initial clinical practicum, consequently proactively helping reduce potential anxiety experiences.

Clinical supervision in primary health care; experiences of district nurses as clinical supervisors - a qualitative study

BACKGROUND

Learning in the clinical environment is an important part of nursing education. Several recent studies focusing on clinical learning have been based on hospital settings. Little is known about primary health care (PHC) as clinical environment where district nurses (DNs) or nurses supervise students. It is important to understand more about opportunities and difficulties in supervising in this area in order to develop PHC as an optimal learning environment for nursing students. The main objective of this study was to gain an understanding of supervisors' experiences of supervising undergraduate students at PHC units.

METHODS

A qualitative research approach was used to collect data and analyse supervisors' experiences. Six focus groups were carried out with 24 supervisors. Focus group data were audio-taped. The data were analysed using an inductive content analysis.

RESULTS

Three themes illustrated supervisors' experiences: abandonment, ambivalence and sharing the holistic approach. Supervisors felt abandoned by their managers, colleagues and nurse teachers from universities. They experienced ambivalence due to simultaneously being supervisors for students and carrying out their daily work with patients. At the same time, they were proud to be DNs and willing to share their unique role to apply a holistic approach and continuity in patient care with students.

CONCLUSION

When supervising students in PHC, social support and communication between supervisors and their colleagues and management as well as nurse teachers need to be taken into consideration both at universities and at primary health care units.

Enhancing undergraduate community placements: a critical review of current literature

In the face of the UK-wide policy shift to increased home care, inspiring and enabling the next generation of community nurses is more urgent than ever. The quality of the pre-registration practice learning experience is highly influential on career choices at the point of qualification. Given that 50% of learning by pre-registration students takes place in practice, mentors have a crucial role to play in preparing the next generation of nurses to work in the community. This article discusses the findings of a systematic and critical literature review of pre-registration placements that was funded by the Queen's Nursing Institute Scotland. The review found that students' experiences of learning in community settings are variable, and perceptions of students and mentors are misaligned in terms of what a quality placement should look like. Although there is no clear definition of what constitutes a community placement and there is some underuse of learning environments in areas such as general practice nursing, there are also a number of examples of new and imaginative placements. While these innovations provide 'whole experience' placements, they are currently lacking robust evaluation, despite their potential usefulness on a larger scale. Mentors have the opportunity to provide students with a range of learning opportunities that increase preparedness for working in the community, allowing final year students in particular greater influence over their learning experience. Students undertaking community practice learning, where they have a managed level of autonomy, are more likely to feel confident to take on community nursing roles.

Factors associated with student learning processes in primary health care units: a questionnaire study

BACKGROUND

Clinical placement plays a key role in education intended to develop nursing and caregiving skills. Studies of nursing students' clinical learning experiences show that these dimensions affect learning processes: (i) supervisory relationship, (ii) pedagogical atmosphere, (iii) management leadership style, (iv) premises of nursing care on the ward, and (v) nursing teachers' roles. Few empirical studies address the probability of an association between these dimensions and factors such as student (a) motivation, (b) satisfaction with clinical placement, and (c) experiences with professional role models.

OBJECTIVE

The study aimed to investigate factors associated with the five dimensions in clinical learning environments within primary health care units.

DESIGN AND METHODS

The Swedish version of Clinical Learning Environment, Supervision and Teacher, a validated evaluation scale, was administered to 356 graduating nursing students after four or five weeks clinical placement in primary health care units. Response rate was 84%. Multivariate analysis of variance is determined if the five dimensions are associated with factors a, b, and c above.

RESULTS

The analysis revealed a statistically significant association with the five dimensions and two factors: students' motivation and experiences with professional role models. The satisfaction factor had a statistically significant association (effect size was high) with all dimensions; this clearly indicates that students experienced satisfaction.

CONCLUSIONS

These questionnaire results show that a good clinical learning experience constitutes a complex whole (totality) that involves several interacting factors. Supervisory relationship and pedagogical atmosphere particularly influenced students' satisfaction and motivation. These results provide valuable decision-support material for clinical education planning, implementation, and management.

Nursing students' perceptions of their clinical learning environment in placements outside traditional hospital settings

AIMS AND OBJECTIVES

To explore students' opinions of the learning environment during clinical placement in settings outside traditional hospital settings.

BACKGROUND

Clinical placement experiences may influence positively on nursing students attitudes towards the clinical setting in question. Most studies exploring the quality of clinical placements have targeted students' experience in hospital settings. The number of studies exploring students' experiences of the learning environment in healthcare settings outside of the hospital venue does not match the growing importance of such settings in the delivery of health care, nor the growing number of nurses needed in these venues.

DESIGN

A survey design was used.

METHOD

The Clinical Learning Environment Inventory was administered to two cohorts of undergraduate nursing students (n = 184) after clinical placement in mental health care, home care and nursing home care.

RESULTS

Nursing students' overall contentment with the learning environment was quite similar across all three placement areas. Students in mental health care had significantly higher scores on the subscale individualisation, and older students had significantly higher scores on the total scale. Compared with other studies where the Clinical Learning Environment Inventory has been used, the students' total scores in this study are similar or higher than scores in studies including students from hospital settings.

CONCLUSION

Results from this study negate the negative views on clinical placements outside the hospital setting, especially those related to placements in nursing homes and mental healthcare settings.

RELEVANCE TO CLINICAL PRACTICE

Students' experience of the learning environment during placements in mental health care, home care and nursing homes indicates the relevance of clinical education in settings outside the hospital setting.

Teaching methods in community health nursing clerkships: experiences of healthcare staff in Iran

PURPOSE

Healthcare staff educate nursing students during their clerkships at community health nursing programs. Their teaching methods play an important role in nursing students' acquisition of competencies; however, these methods have not been studied thoroughly. Thus, this study aims to describe, interpret, and understand the experiences of healthcare staff's teaching methods in clerkships at a community health nursing program.

METHODS

This study was conducted using purposeful sampling and semi-structured interviews with 13 members of the staff of three urban healthcare centers in Iran. The data were analyzed through qualitative content analysis and thematic analysis.

RESULTS

Multiplicity of teaching was identified as the main category of teaching method, and the five subcategories were teaching through lecture, demonstration, doing, visits and field trips, and readiness. The most common method used by the healthcare staff was lecturing.

CONCLUSION

The healthcare staff used multiple methods to teach students in the nursing clerkship of the community health program, which was the strength of the course. However, they should be familiar with, and utilize additional methods, such as discussion rather than lecture.

El diario del estudiante de enfermería en la práctica clínica frente a los diarios realizados en otras disciplinas. Una revisión integradora

El presente artículo es una revisión integradora de la literatura cuyo objetivo fue identificar, en revistas nacionales e internacionales indexadas en las bases de datos Isi Web of Knowledge, Eric, PubMed, EbscoHost, Scopus, SciELO, Cuiden, Cuidatge y Scirus, en el periodo comprendido entre 1995 y 2011, datos que contribuyeran a determinar cómo la escritura del diario reflexivo ayuda al estudiante de enfermería durante sus prácticas clínicas, así como a establecer diferencias y similitudes con los diarios realizados por estudiantes de otras disciplinas. Se llevó a cabo una revisión amplia de la cual se seleccionaron 54 artículos científicos con base en criterios de inclusión y exclusión, sin descartar ninguna metodología de investigación e incluyendo aquellos que analizaran el diario del estudiante, fueran o no del ámbito de la enfermería. Se concluye que la escritura del diario reflexivo que realiza el estudiante de enfermería durante sus prácticas clínicas tiene beneficios tales como la mejora de la comunicación con el paciente, fundamental para el cuidado. La escritura del diario debería ser incluida en todos los planes de estudio de grado en el ámbito de las prácticas clínicas.

The role of the sign-off mentor in the community setting

In an move to identify nursing as an all-graduate profession, the Nursi Midwifery Council standards identified that future nurses need to be equipped with the skills and knowledge to lead and deliver high-quality care. Inorder to have these skills within the changing context of health care, students need to experience care delivery across a range of community, hospital and other settings. Students have to undertake a final clinical placement of 12 weeks at the end of their programme, commonly called a consolidation placement, and are allocated a sign-off mentor to confirm they meet the requirements for entry to the register. Placement capacity within primary care settings continues to be a challenge alongside the need for providing a sign-off mentor. This article discusses some of the challenges and opportunities of the role of the sign-off mentor and the potential impact for encouraging newly qualified recruitment in this area.

What exposure do student nurses have to Primary Health Care and community nursing during the New Zealand undergraduate Bachelor of Nursing programme?

A research project to examine the theoretical and practical exposure student nurses have to Primary Health Care (PHC) and community nursing in their undergraduate programme was undertaken in New Zealand (NZ). Providing quality clinical placements for health care students is acknowledged as a major challenge for tertiary institutions. In order to reflect the current shift in health care delivery from hospital to community settings, one such challenge is to ensure students receive appropriate theoretical programme content and clinical experience in PHC and community settings. The project consisted of a review of relevant international literature, and a questionnaire sent to all NZ tertiary institutions providing a Bachelor of Nursing (BN). Findings included a variable understanding of the concept of PHC, a lack of appropriate PHC placements across the country, competition for student placements in PHC, and professional organisation requirements for student supervision impacting on placement availability. Innovations identified to increase PHC placements comprised the establishment of Dedicated Education Units (DEUs), curriculum revision, and final year PHC placements offered only to students targeting PHC settings on registration. Study recommendations involve establishing a regional rather than a local approach to managing clinical placements, increasing professional governance support and reviewing clinical placement funding.

Preparing nursing students to be community health practitioners

There is currently a greater emphasis on community-based health care and, with that, a shift in focus for pre-registration nursing education within policy documents and standards (Nursing and Midwifery Council (NMC), 2010). This paper reports a mixed methods study that examined the implementation of an initiative that enabled third year adult field student nurses the opportunity to spend the final year of their education within the community setting. Using a questionnaire and focus groups, the views of students at the end of the 12-month period were captured. The diverse approach to the placement provision enabled undergraduate nurses to be fit for purpose and ensured that practice at the point of registration would meet the challenges of working in the community setting. Students developed confidence through the diverse placement provision, opportunities for lone working and the support provided by mentors. This model of placement provision is worthy of consideration by service leads and curriculum planners, particularly in view of the present focus of the NMC's (2010) standards for pre-registration nursing programmes.

Practice nurses experiences of mentoring undergraduate nursing students in Australian general practice

Internationally, the delivery of health services has shifted from secondary to primary care, necessitating an exponential growth of the nursing workforce and expansion of the nursing role in general practice. This growth, and the subsequent need to develop this workforce, has created a need to expose undergraduate nurses to general practice nursing as a viable career option. Concurrently, universities are struggling to find sufficient clinical places for their undergraduate students to gain clinical experience. It is logical, therefore, to increase the number of undergraduate nursing student placements in general practice. Through qualitative research methods, this paper seeks to explore the experiences of practice nurses mentoring undergraduate students on clinical placements within the general practice setting. Findings are presented in the following three themes: (1) Promoting Practice Nursing: We really need to get students in, (2) Mentoring future co-workers: Patience and reassurance, and (3) Reciprocity in learning: It's a bit of a two way street, which show the benefits of such placements. Clinical placements in general practice settings can be mutually beneficial in terms of providing quality teaching and learning experiences for students. Conversely, the experience provides an impetus for practice nurses to maintain currency of their clinical skills and knowledge through mentoring student nurses.