Community of practice in healthcare: An investigation on nursing students' perceived respect

'It's a gamble': A phenomenological exploration of medical students' learning experiences as newcomers to clinical communities of practice

BACKGROUND

Medical students become members of the clinical team through participation in their activities, as described by Lave and Wenger's situated learning theory. While there is research into how medical students cognitively engage in clinical learning, there is limited work on clinical experiences using a social theoretical lens such as situated learning theory.

METHOD

This study explored third year medical students' lived experience as newcomers to clinical teams using a qualitative phenomenological approach. Medical students completed in-depth, semi-structured interviews in 2021. Interpretive phenomenological analysis (IPA) using Lave and Wenger's theory of situated learning was applied to understand students' experiences.

RESULTS

Seven students discussed their variable placement experiences. Learning related to three elements: conditions for participation, modes of participation and products of participation. When certain conditions were met relating to student, clinician and activity, students learned. This drove identity and relationship formation. The findings related and led to a self-perpetuating cycle with potential to advance student learning. When the conditions for participation were not met, the cycle stopped, leading to student disengagement.

CONCLUSION

Passivity in students is a result of modifiable factors in the workplace. To encourage proactivity, clinicians must enable students to move from observation to participation as their competence increases. Participation should be supervised, challenging and should contribute to patient care. Time pressures can make this difficult; one solution is to nominate a clinician to direct students and account for this in their workload or to employ a clinical fellow to assist with student training.

'They're not doing too much are they?' How the socialization of registered nurses perpetuates status differences with certified nursing assistants: A qualitative study

BACKGROUND

Limited knowledge exists about how the socialization of vocationally trained registered nurses both at school and during internships in the community of practice influences their perception of, and working relationship with certified nursing assistants.

OBJECTIVES

This paper studies, first, how registered nurse students internalize the perceptions and discourses about certified nursing assistants conveyed by teachers, mentors and other students during their socialization at school and in the community of practice. Second, it examines how this socialization forms student's perception of, and actual working relationship with certified nursing assistants.

DESIGN

Qualitative descriptive and exploratory study using an interpretative framework.

METHODS

Individual in-depth interviews were conducted with 15 registered nurse students that were in their third or fourth year of training.

RESULTS

The findings reveal that at school the division of tasks and working relationship between registered nurse students and certified nursing assistants was very rarely discussed explicitly. However, teachers and students implicitly and explicitly conveyed that certified nursing assistants have lower status, describing the latter's role as inferior and as assisting to the role of registered nurses. During internships in the community of practice, some students initially adjust this perception when directly working with certified nursing assistants, who generally are their mentor in the first years of training, consider certified nursing assistants as equal and highlight the interdependence of the two occupational groups. Yet, further in their training, registered nurse students start to relate more to graduated registered nurses and reproduce the dominant perception and discourse that certified nursing assistants are inferior and supposed to support registered nurses, thereby perpetuating pervasive status differences and inequality.

CONCLUSION

Findings will assist nurse educators both in training centers and in the community of practice to understand how education can be used to end pervasive status differences and foster mutual respect and equity between different designations in nursing.

The effect of community of practice in improving the role of clinical instructor in patient safety implementation by prelicensure nursing students

Introduction: Patient safety problems caused by students leads to different adverse event, hence clinical instructor plays a role in guiding them in the implementation of patient safety programs. Furthermore, the community of practice is considered to improve the role of clinical instructors in patient safety problems. This study is then conducted to measure the impact of community of practice toward the role of clinical instructors in patient safety problems. Design and methods: This is a pre-experimental design for one group and a pre-post test design without a control group. In addition, the sample includes 36 prelicensure nursing students. Result: The results showed that the score of clinical instructors’ role before and after intervention with community of practice implementation was 58 (34-67) and 79.33 with SD of 10,960, respectively, with a significant increase of 24.27. Also, the statistic analysis depicted that the role had a significant effect after implementation, with a p-value of < 0,000. Conclusions: Based on the results, the community of practice had a significant impact in increasing the role of clinical instructors in the implementation of patient safety problems by prelicensure nursing students.  

Applications of social theories of learning in health professions education programs: A scoping review

Introduction

In health professions education (HPE), acknowledging and understanding the theories behind the learning process is important in optimizing learning environments, enhancing efficiency, and harmonizing the education system. Hence, it is argued that learning theories should influence educational curricula, interventions planning, implementation, and evaluation in health professions education programs (HPEPs). However, learning theories are not regularly and consistently implemented in educational practices, partly due to a paucity of specific in-context examples to help educators consider the relevance of the theories to their teaching setting. This scoping review attempts to provide an overview of the use of social theories of learning (SToLs) in HPEPs.

Method

A scoping search strategy was designed to identify the relevant articles using two key concepts: SToLs, and HPEPs. Four databases (PubMed, ERIC, ProQuest, and Cochrane) were searched for primary research studies published in English from 2011 to 2020. No study design restrictions were applied. Data analysis involved a descriptive qualitative and quantitative summary according to the SToL identified, context of use, and included discipline.

Results

Nine studies met the inclusion criteria and were included in the analysis. Only two SToLs were identified in this review: Bandura's social learning theory (n = 5) and Lave and Wenger's communities of practice (CoP) theory (n = 4). A total of five studies used SToLs in nursing programs, one in medicine, one in pharmacy, and two used SToLs in multi-disciplinary programs. SToLs were predominantly used in teaching and learning (n = 7), with the remaining focusing on assessment (n = 1) and curriculum design (n = 1).

Conclusions

This review illustrated the successful and effective use of SToLs in different HPEPs, which can be used as a guide for educators and researchers on the application of SToLs in other HPEPs. However, the limited number of HPEPs that apply and report the use of SToLs suggests a potential disconnect between SToLs and educational practices. Therefore, this review supports earlier calls for collaborative reform initiatives to enhance the optimal use of SToLs in HPEPs. Future research should focus on the applicability and usefulness of other theories of learning in HPEPs and on measuring implementation outcomes.

Systematic Review Registration:https://www.researchregistry.com/browse-the-registry#registryofsystematicreviewsmetaanalyses/registryofsystematicreviewsmeta-analysesdetails/60070249970590001bd06f38/, identifier review registry1069.

From registered nurse to nursing student - Exploring registered nurses' transition to nursing student during a post-registration children's nurse programme: A qualitative descriptive research study

BACKGROUND

Registration as a children's nurse in Ireland occurs via two routes, an undergraduate degree in children's and general nursing and a twelve-month post-registration children's nurse programme. Candidates undertaking the latter are experienced nurses on the register for either general, intellectual disability or mental health nursing yet they are required to become a nursing student for the duration of the programme. Although anecdotal evidence indicates that this presents unique challenges for these students the experiences of transitioning from registered nurse to nursing student has not been explored since inception of the programme in 2006.

OBJECTIVES

The study aimed to explore the experiences of the registered nurse that transitioned to nursing student during the Post-registration Children's Nurse Programme, to identify the previous experience of the registered nurse and to identify what challenged and supported successful transition.

DESIGN

A qualitative descriptive research design was used.

SETTING

The study was carried out in a large teaching children's hospital in Dublin, Ireland.

PARTICIPANTS

A purposeful sample of six registered nurses that completed the programme within the last 12 months was interviewed about their experiences of being a post-registration nursing student.

METHODS

Face-to-face, semi-structured, conversation-style interviews were conducted.

RESULTS

Four main themes were identified from the data: 'Feelings related to returning to student status', 'Supports throughout the transition', 'Differences between disciplines' and 'Knowing your place'. Registered General Nurses (RGN) had different learning needs in comparison to registered nurses in intellectual disability (RNID) and expressed difficulty adapting to the role of nursing student as they felt that their previous knowledge and experience was being overlooked. In contrast, RNIDs were more challenged on clinical placement by unfamiliarity with clinical equipment and terminology. Both RNIDs and RGNs found that the nursing staff on their placements were a source of support despite reporting that they rarely worked with their designated preceptor.

CONCLUSIONS

The challenges experienced by nursing students from different nursing disciplines sharing the same post-registration programme needs to be considered in the planning and implementation of all aspects of the programme. Healthcare staff should become more aware of the challenges experienced by the postgraduate nursing student when educating and supporting their learning within the preceptor-student relationship.

Engaging nurses in health policy in the era of COVID-19

Nurses have a unique place in redesigning the future of healthcare, particularly after experiencing health policy failures with the coronavirus disease 2019 pandemic. Nurses consistently outperform other professions to enjoy a decades‐long reputation as the most trusted profession. Nevertheless, the nursing voice is missing at a public level; representation in governments and boardrooms negligible. While nurses carry out health policy, rarely are they involved informing policy. While substantial dialog on health system reform, regulatory changes, care coordination, and health information technology occurs, nursing's presence is absent. The barriers are many: a lack of political sophistication, family, and work demands limiting time, and a lack of confidence. Using the Yoder‐Wise Framework for Planned Policy Change, opportunities for engagement at each step in the process are made clear. Workplace opportunities provide entry‐level representation and exposure to the machinations of governance. Nursing professional associations provide similar opportunities. For many nurses, social media, while not without its risks, offers a familiar and accessible platform by which to engage patients, the public, and policymakers in planned, strategic steps to create policy change and improve healthcare for patients.

Revisión de la literatura sobre la violencia y sus implicaciones en la formación en enfermería

Introducción: La violencia es un fenómeno social complejo, que se manifiesta en varios sectores de la sociedad contemporánea. Los actos violentos están presentes en los procesos de formación en diferentes áreas del conocimiento, como el pregrado en enfermería. Objetivo: Identificar la forma en que se presenta la violencia en el pregrado de enfermería y las posibles implicaciones para la formación de los estudiantes. Materiales y métodos: Se realizó una revisión integradora en la biblioteca virtual SciELO® , las bases de datos ERIC®, LILACS®, Web of Science®, MEDLINE®, CINAHL®, Scopus®  y Google Académico®, con la que se recuperaron 21 documentos para el período entre 2014 y 2018. Resultados: El análisis permitió organizar los resultados en cuatro categorías: caracterización de estudios y autores; comprensión y naturaleza de la violencia; espacios en los que ocurre la violencia y los principales perpetradores; y las consecuencias generadas por la violencia y las acciones para enfrentar el fenómeno. Discusión: Los actos violentos afectan las condiciones de vida de los involucrados, impactan negativamente el desarrollo de habilidades relacionadas con la interacción interpersonal y generan debilidades en la formación de futuros enfermeros. Conclusiones: La violencia es un fenómeno constante en el contexto del pregrado en enfermería, para lo que es necesario promover el fortalecimiento de una cultura de paz en este entorno. Como citar este artículo: Maffissoni, André Lucas; Sanes, Marina da Silva; Oliveira, Saionara Nunes; Martini, Jussara Gue; Lino, Monica Motta. Violência e suas implicações na formação em enfermagem: revisão da literatura. Revista Cuidarte. 2020; 11(2): e1064. http://dx.doi.org/10.15649/cuidarte.1064

Providing Personal Care to Patients: the Role of Nursing Students' Emotional Labor

Background Providing personal care may be a source of emotional difficulties and negative feelings for students interacting with patients during their first clinical placement. This study was done to describe the role of emotional strategies for first year nursing students providing personal care to patients and the relationship of these strategies to students' emotional exhaustion, self-efficacy, and turnover intention. Method A self-reported questionnaire was administrated to a convenience sample of 226 first-year undergraduate nursing students attending their first clinical placement in one Italian University hospital. Results Results suggested a positive link between students' cognitive re-evaluation of their experiences and their self-perceived self-efficacy. Attentional deployment was the strongest antecedent of emotional exhaustion. Emotional dissonance was the primary contributor to students' turnover intention. Emotional exhaustion mediated the relationship between emotional dissonance and turnover intention. Conclusion This research suggested that there are emotional coping strategies useful for protecting student nurses from emotional exhaustion and turnover intention and that these strategies are positively related to students' self-perceived self-efficacy in providing personal care.

Lack of respect, role uncertainty and satisfaction with clinical practice among nursing students: the moderating role of supportive staff

BACKGROUND AND AIMS

Clinical learning placements provide a real-world context where nursing students can acquire clinical skills and the attitudes that are the hallmark of the nursing profession. Nonetheless, nursing students often report dissatisfaction with their clinical placements. The aim of this study was to test a model of the relationship between student's perceived respect, role uncertainty, staff support, and satisfaction with clinical practice.

METHOD

A cross-sectional, descriptive survey was completed by 278 second- and third-year undergraduate nursing students. Specifically, we tested the moderating role of supportive staff and the mediating role of role uncertainty.

RESULTS

We found that lack of respect was positively related to role uncertainty, and this relationship was moderated by supportive staff, especially at lower levels. Also, role uncertainty was a mediator of the relationship between lack of respect and internship satisfaction; lack of respect increased role uncertainty, which in turn was related to minor satisfaction with clinical practice.

CONCLUSION

This study explored the experience of nursing students during their clinical learning placements. Unhealthy placement environments, characterized by lack of respect, trust, and support increase nursing students' psychosocial risks, thus reducing their satisfaction with their clinical placements. Due to the current global nursing shortage, our results may have important implications for graduate recruitment, retention of young nurses, and professional progression.