Perceived clinical constraints in the nurse student–instructor interactions: A qualitative study

A National Survey of Collaboration Between Nurse Faculty Members and Staff Nurses in the Clinical Learning Environment

AIM

The purpose of this study was to measure collaboration in the clinical learning environment.

BACKGROUND

Clinical learning, which is essential for nursing education, allows students to integrate what they have learned in the classroom in a complex social context with an interactive network of forces. Stakeholders are nursing students, nursing faculty, and staff nurses who must collaborate in providing an effective learning environment for students.

METHOD

Quantitative data were collected via the Collaboration in the Clinical Learning Environment tool, an author-developed 24-item Likert scale designed to measure the amount of collaboration between staff nurses and nursing faculty members in the clinical learning environment.

RESULTS

Three groups (n = 882) were surveyed: staff nurses, nurse faculty, and nurses who worked concurrently in academia and practice.

CONCLUSION

This study adds to the literature on collaboration between nursing faculty members and staff nurses. It also highlights areas for improvement for both parties.

Enablers of the interpersonal relationship between registered nurses and students on clinical placement: A phenomenological study

AIM/OBJECTIVE

The aim of this qualitative study was to explore the lived experiences (nature and extent) of the interpersonal relationship between RNs and students during clinical placement.

BACKGROUND

In Australia, as elsewhere, nursing students' clinical placements are facilitated and supervised by registered nurses (RNs). There is evidence of positive teaching and learning interactions between RNs and students influencing student placement outcomes. Comparatively, little is known about the value of interpersonal relationships between RNs and students in the contribution to positive placement experiences.

DESIGN

A descriptive phenomenological approach was used to investigate the interpersonal relationship between RNs and students from the perspective of the lived experience of the RN.

METHOD

In depth, semi-structured interviews were conducted with ten RNs and analysed using Colaizzi's seven-step analytical approach.

RESULTS

Study findings revealed that RNs are committed to building positive interpersonal relationships with students to enhance learning and achieve successful clinical learning outcomes. Positive relationships are enabled through factors encompassing three overarching themes; Getting to know the student is essential; Effective communication is a reciprocal process, and Mutuality of engagement and commitment is critical. Vital to the relationship was the capacity to know the student, communicate with them openly and effectively, and have a mutually engaging, committed relationship with them.

CONCLUSIONS

The establishment of positive interpersonal relationships is important to the RNs who facilitate and supervise the clinical learning of nursing students for meaningful learning and successful student outcomes. Key findings included that getting to know the student is essential, effective communication is a reciprocal process, and mutuality of engagement and commitment is critical to building a positive relationship. Findings can be utilised to advise professional development for RNs who work with students on clinical placement with regard to the importance of developing positive interpersonal relationships with students and the characteristics that enable that to occur. The primacy of the relationship, brought about through RNs requirement to facilitate student clinical learning needs acknowledgement. Also, the importance of the interpersonal relationship for RNs and students needs recognition by both, to help them achieve success in clinical placements through effective interpersonal and professional relationships which promote good learning opportunities.

Towards an Open Medical School without Checkerboards during the COVID-19 Pandemic: How to Flexibly Self-Manage General Surgery Practices in Hospitals?

Background: Can we create a technological solution to flexibly self-manage undergraduate General Surgery practices within hospitals? Before the pandemic, the management of clerkships was starting to depend less on checkerboards. This study aims to explore undergraduates’ perceptions of doing rotations in teaching hospitals using different teaching styles and elicit their views regarding the options of managing practices to design a mobile app that substitutes for checkerboards. Methods: In this sequential exploratory mixed methods study, 38 semi-structured interviews at a teaching hospital were conducted. The data was used to survey 124 students doing their rotations in four teaching hospitals during the first wave of COVID-19. Results: 21 themes highlighted concerns related to the practices, the teacher involvement in the students’ education, and the students’ adaptation to clinical culture. The students reported positive perceptions concerning self-managing and organizing practices via a mobile application. However, problems emerged regarding transparency, the lack of feedback, and the need for new tools. Regarding the teaching styles, the facilitator and personal models were perceived as optimal, but the personal style had no effect on using or not using a tool. Conclusions: A mobile-learning application designed like an educational opportunities’ manager tool can probably promote self-directed learning, flexible teaching, and bidirectional assessments. However, teachers who employ a personal teaching style may not need either checkerboards or a tool. This solution supports teaching at hospitals in pandemic times without checkerboards.

Exploring clinical educators' perceptions of role modeling after participating in a role modeling educational program

INTRODUCTION

Role modeling significantly affects medical students' values, attitudes, and professional behaviors. Role modeling is a complex and multidimensional process that necessitates accurate perception and adequate knowledge and skills. However, most clinical educators do not have adequate awareness and knowledge about the positive and negative effects of role modeling. We aimed to explore clinical educators' perceptions of role modeling after participating in a role modeling educational program.

METHODS

This qualitative study was conducted on eighteen clinical educators who were voluntarily participated in a three-month role modeling educational program. Data were collected using reflection paper writing and were analyzed through conventional content analysis.

RESULTS

Data analysis resulted in the development of three main categories, namely closer attention to role modeling and effort for its promotion, deliberate effort to display role modeling, and creating a positive environment to increase the effectiveness of role modeling.

CONCLUSIONS

Clinical educators have limited role modeling knowledge and skills, and hence, educational programs are required to improve their role modeling knowledge, attitudes, and skills. Role modeling educational programs should aim at developing educators' awareness and knowledge about role modeling, develop their reflection and self-control abilities, and sensitize them to the importance of deliberate use of role modeling.

Nurse trainees' perception of effective clinical instructor characteristics

Objectives

Clinical education and experience in the clinical environment play an important role in shaping the clinical experience. Effective clinical teaching improves the clinical practice of the nursing trainees which in turn improves the quality of patient care. It mandates for the clinical instructor with desired qualities, to have a positive influence in clinical education. This study examined nurse trainees’ perceptions of clinical instructor characteristics.

Methods

The current study was conducted in a multi-cultural tertiary setting using a cross-sectional descriptive design. Using convenience sampling, 302 trainees were chosen as participants for the study, and there were 296 respondents. The data were collected from the participants using the Nursing Clinical Teacher Effectiveness Inventory (NCTEI) tool.

Results

The findings of the study revealed that the clinical instructors have scored high in personality (scoring percentage = 84.0%) and relatively low in teaching ability (scoring percentage = 81.3%). Also, the overall perception was almost the same among all the trainees though there was a slight variation in their rating of each dimension.

Conclusions

Nursing trainees indicated the instructors as having good personality and relatively low teaching ability. This mandates the clinical instructors in the clinical environment to empower themselves in this area of improvement. This helps the teaching institutions to consider all the domains of effective clinical instructor characteristics while recruitment and also organize programs giving emphasis on building and developing these characteristics to create effective instructors.

Assessment of reliability and validity of the Spanish version of the Nursing Students' Perception of Instructor Caring (S-NSPIC)

The care that clinical instructors demonstrate to students is essential for their education, considering the strong impact it has on their future relationships with patients, relatives, and other health professionals. Nursing Students’ Perceptions of Instructor Caring (NSPIC) is an instrument designed to assess nursing students’ perceptions of instructor’s caring behaviors. A trans-cultural, conceptual, and psychometric validation study was conducted with 315 nursing students at the University of Seville during their clinical practices in three regional hospitals. The NSPIC was translated and adapted to Spanish. The content validity was established by a panel of experts. To assess concurrent validity the culturally adapted Spanish version of the Clinical Placement Evaluation Tool (CPET) was used as a gold standard. The construct validity was determined by an exploratory factor analysis to identify the internal structure of the NSPIC-S. The internal consistency was established by Cronbach’s α and the intra-observer reliability for each item was established by test-retest. The content validity index varied between 0.53 and 0.93 and the correlation to the CPET was moderate. The factor analysis revealed a structure of five factors, one of which differed from the original scale. The value of Cronbach’s α was 0.95 and intraclass correlation coefficients varied between 0.5 and 0.89. Our study provided a culturally adapted version of the NSPIC, valid and reliable to be used in the Spanish context, the NSPIC-S.

Learning Situations in Nursing Education: A Concept Analysis

Background and purpose:

The nursing student requires opportunities to learn within authentic contexts so as to enable safe and competent practice. One strategy to facilitate such learning is the creation of learning situations. A lack of studies on the learning situation in nursing and other health care fields has resulted in insufficient knowledge of the characteristics of the learning situation, its antecedents, and consequences. Nurse educators need to have comprehensive and practical knowledge of the definition and characteristics of the learning situation so as to enable their students to achieve enhanced learning outcomes. The aim of this study was to clarify the concept of the learning situation as it relates to the education of nurses and improve understanding of its characteristics, antecedents, and consequences.

Methods:

The Bonis method of concept analysis, as derived from the Rodgers’ evolutionary method, provided the framework for analysis. Data collection and analysis were undertaken in two phases: “interdisciplinary” and “intra-disciplinary.” The data source was a search of the literature, encompassing nursing and allied health care professions, published from 1975 to 2016.

Results:

No agreement on the conceptual phenomenon was discovered in the international literature. The concept of a learning situation was used generally in two ways and thus classified into the themes of: “formal/informal learning situation” and “biologic/nonbiologic learning situation.” Antecedents to the creation of a learning situation included personal and environmental factors. The characteristics of a learning situation were described in terms of being complex, dynamic, and offering potential and effective learning opportunities. Consequences of the learning situation included enhancement of the students’ learning, professionalization, and socialization into the professional role.

Implication for Practice:

The nurse educator, when considering the application of the concept of a learning situation in their educational planning, must acknowledge that the application of this concept will include the student’s clinical learning experiences. More studies are required to determine factors influencing the creation of a successful learning situation from the perspectives of nurse educators and nursing students, clinical nurses and patients.

Effect of a clinical skills refresher course on the clinical performance, anxiety and self-efficacy of the final year undergraduate nursing students

Although the final year of nursing undergraduate programs that focus on clinical education are planned to prepare nursing students to better transition to the real world of health care service; evidence has shown that this program is not sufficient to reach this end goal. This controlled trial study was to investigate the effectiveness of a basic clinical skills refresher course for nursing students before entering the internship program. The sample consisted of 160 undergraduate nursing students assigned into two groups. The intervention was a three-day refresher course directed by nurse instructors for intervention group focused on 10 basic nursing procedures in the clinical skill lab. The control group did not receive any intervention. The students' anxiety, clinical self- efficacy and clinical skills practice were measured before and after intervention in both groups. The results indicated that the students who took part in the refresher course experienced lower anxiety levels, higher levels of clinical self-efficacy, and have better clinical skills during their internships. The undergraduate nursing curriculum can be strengthened by the basic clinical skills refresher course. This refresher course can bridge the theory - practice gap and provide a better transition from the student to nurse role.

Power dynamics in the student-teacher relationship in clinical settings

BACKGROUND

Among many factors that influence clinical learning, the teacher-student relationship has been found to be crucial. The imbalance of power in that relationship tends to be regarded as negative, but how students actually perceive the power within the relationship is unknown.

AIM

This study explored nurse students' perceptions of the power dynamics in the teacher-student relationship during their clinical placement.

DESIGN

A descriptive qualitative study.

METHODS

A total of 51 students were recruited from a nursing school in Hong Kong. Seven focus group interviews consisted of three groups of Year 3 students (n=26) and four groups of final year students (n=25). A semi-structured interview guideline was designed. Content analysis was employed to analyse the research data.

RESULTS

The three core themes that emerged from the qualitative data were: (1) meanings of power - avoiding doing harm to patients; (2) the desired power dynamics - master vs apprentice; and (3) enhancing the clinical learning experience.

CONCLUSIONS

The dominant theme in the participants' discourse was that teachers should possess more power than students in order to prevent students from causing harm to patients. The consensus was that the teacher's power in supervising students' clinical practice is accepted and necessary for the benefit of patient safety. The cultural relevance of the power dynamics in the teacher-student relationship should be embraced in order to understand the student's perspective.

Clinical Faculty Management of the Challenges of Being a Guest in Clinical Settings: An Exploratory Study

BACKGROUND

Clinical experience is a critical component of basic nursing education. Little research has focused on the perspectives of clinical faculty (CF) who engage in practical nursing education in challenging clinical settings associated with increased patient acuity and complexity.

METHOD

The aim of this qualitative study was to understand CF's perspectives of what supports and hinders their ability to foster baccalaureate nursing students' clinical education.

RESULTS

Findings indicate challenges related to CF being viewed as "guests" in the clinical settings, complicating communication with nursing staff about constructive learning experiences. CF receive support from other CF to assist in balancing student priorities and developing relationships with clinical staff .

CONCLUSION

CF success was linked to how well they advance the view of students and themselves as being an integral part of the nursing team. Further research is needed to understand how CF use their social capital to advance clinical nursing education.

Humanistic approach to nursing education: lived experiences of Iranian nursing students

The nurse teachers tried to have a complete understanding of the educational contents, to transfer knowledge to nursing students better, and to facilitate the process of education. The purpose of this study was to explore the lived experiences of Iranian nursing students regarding the characteristics of academic nurse teachers. In this hermeneutic phenomenological study, data were collected via in-depth, semi-structured interviews with 12 Iranian nursing students and the audio-taped and transcribed interviews analyzed according to Van Manen´s method. The main theme emerged during data analysis, was “humanistic approach to nursing education”. The theme was extracted from 2 sub-themes including ‘ethical necessities’ and ‘effective interaction’. The findings present greater understanding of humanistic approach to nursing education.