Time, fear and transformation: Student nurses’ experiences of doing a practicum (quality improvement project) in practice

A Multisite Study of a Quality Improvement Teaching Strategy to Build Competency

BACKGROUND

Quality improvement (QI) is an essential part of nursing education. Although there are robust examples of teaching strategies for QI, there is a distinct lack of research on effective strategies for teaching QI in nursing education.

METHOD

This multisite study included students from six nursing programs. A treatment fidelity plan was developed and followed to ensure consistency for implementation of the study and data collection. A quasiexperimental, nonpaired, pre- and posttest study design was used to examine changes in student perspectives of QI after participating in a QI teaching strategy. Pre- and posttest questions were mapped to the American Association of Colleges of Nursing's Essentials subcompetency statements for QI.

RESULTS

A total of 254 pre- and 116 posttest responses were included for analysis. Significance (p = .05) was found at the beginning level within three questions.

CONCLUSION

Findings from this study indicate beginning-level students can benefit from a competency-based QI learning activity. [J Nurs Educ. 2024;63(1):38-42.].

Nursing students' learning flow, self-efficacy and satisfaction in virtual clinical simulation and clinical case seminar

BACKGROUND

Virtual clinical simulations and clinical case seminar become widely utilized to address these constraints and help nursing students acquire clinical competencies as the limitations on practicum opportunities have been intensified by the COVID-19 pandemic. The purpose of this study was to examine learning flow, self-efficacy and satisfaction in virtual clinical simulation and clinical case seminar among nursing students.

METHODS

A descriptive cross-sectional study was used. Forty-two junior nursing students completed survey questionnaires after participating in computer-based virtual clinical simulation and clinical case seminar, which aimed at acquiring knowledge and care skills in geriatric nursing.

RESULTS

Significant differences in two methods were found in learning flow which included challenge-skill balance (t = -2.24, p < .05) and action-awareness merge (t = -3.32, p < .01). There was no significant difference in learning self-efficacy (t=-1.52, p = .137) and learning satisfaction (t=-0.92, p = .365).

CONCLUSIONS

When there's a mismatch between the perceived challenge and the students' skill levels, it can hinder the learning process. Therefore, instructors should evaluate the clinical skill levels of their students and make necessary adjustments to the difficulty levels of simulation and clinical case seminar accordingly.

How, and under what contexts, do academic-practice partnerships collaborate to implement healthcare improvement education into preregistration nursing curriculums: a realist review protocol

INTRODUCTION

Internationally, healthcare improvement remains a clinical and educational priority. Consensus in Europe, Canada and the USA to implement quality improvement (QI) education into preregistration nursing curricula ensures students become equipped with the skills and knowledge required to improve practice. Now, New Zealand and Australia are beginning to implement QI education into their nursing curricula. However, QI education is complex; comprising multiple components, each influenced by the contexts under which they are developed and implemented. Evaluation studies of QI education unanimously acknowledge that academic and practice partnerships (APPs) are essential to optimally embed QI into preregistration curricula, yet it is not understood how, and under what contexts, APPs collaborate to achieve this.

METHODS AND ANALYSIS

A realist review to determine how, and under what contexts, APPs collaborate to implement QI education in pre-registration nursing will be conducted using the Realist and Meta-narrative Evidence Syntheses: Evolving Standards Guidelines. International stakeholders will be consulted at each stage which includes (1) clarifying the scope of the review through empirical literature and tacit expert knowledge, (2) searching for evidence in healthcare and social science databases/grey literature, (3) appraising studies using the Evidence for Policy and Practice Information and Co-ordinating Centre weight of evidence framework and extracting data using Standards for QUality Improvement Reporting Excellence in Education Publication Guidelines, (4) synthesising evidence and drawing conclusions through the creation of context, mechanism and outcome configurations and (5) disseminating findings through conferences and peer-reviewed publications.

ETHICS AND DISSEMINATION

Ethical approval was not required for this study. Findings will be disseminated to international nurse educators, leaders and front-line staff implementing QI education within their own academic and practice contexts through conferences and peer-reviewed publications.

PROSPERO REGISTRATION NUMBER

CRD42021282424.

An Exploration of Psychological Resilience among Undergraduate Nursing Students Undertaking an Adult Nursing Virtual Practicum during the Coronavirus Pandemic in Taiwan: A Qualitative Study

This qualitative study aimed to explore the psychological resilience of undergraduate nursing students partaking in a virtual practicum during the coronavirus pandemic (COVID-19) in Taiwan. The virtual practicum, a form of online learning, creates challenges compared to the traditional teaching-learning experience of an actual clinical placement. Exploring how students overcome learning difficulties and build resilience is necessary for a new learning environment or for future online learning. Constructivist grounded theory and the Standards for Reporting Qualitative Research checklist were followed. Purposive and theoretical sampling were used to recruit 18 student nurses for data saturation. Semi-structured, face-to-face interviews were conducted individually to collect data. Initial, focused, and theoretical coding and constant comparative data analysis were performed. Credibility, originality, resonance, and usefulness guided the assessment of the study's quality. The core category of psychological resilience in the virtual practicum was constructed to reflect Taiwanese nursing students' progress and experiences of learning during the virtual practicum. This core category consisted of three subcategories: (i) learning difficulties within one's inner self; (ii) staying positive and confident; and (iii) knowing what is possible. The findings identified psychological resilience as an important factor for students to adjust to the adverse experiences of a rapidly changing learning environment, such as the virtual practicum. The substantive theory of psychological resilience provided a frame of reference for coping with possible future difficulties. Correspondingly, psychological resilience reflected individuals' potential characteristics and may help students to enter and remain in the nursing profession.

Partnering with healthcare organisations to teach pre-registration health professions students about quality improvement: A systematic review

AIMS AND OBJECTIVES

To describe what higher education and healthcare organisation partnerships can be identified in the published literature to teach pre-registration health professions students quality improvement and the impact of these partnerships.

BACKGROUND

Quality improvement has been gaining traction in the Western world and has been incorporated in varying degrees into the curricula for pre-registration health professions students. Providing quality improvement education in partnership with healthcare organisations has been found to be a valuable experiential learning solution, but the impacts of higher education and healthcare organisation partnerships have not been explored.

DESIGN AND METHODS

Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic review was undertaken using the Ovid MEDLINE, Emcare, CINAHL, Scopus and Eric databases. Studies were subject to quality appraisal using the Critical Appraisal Skills Program validated tools and a thematic analysis and narrative synthesis was undertaken.

RESULTS

Eight studies were included in this review. Features of existing quality improvement partnerships included experiential learning, time pressures and barriers to successful quality improvement partnerships. The impacts of quality improvement partnerships were demonstrated by an increase in quality improvement knowledge and understanding, students leading change and the implementation of quality improvement projects.

CONCLUSION

Several key elements were identified that may act as barriers or enablers to successful implementation of quality improvement partnerships. This review advances understandings of the need for a shift in focus that pays attention to the culture of teaching quality improvement in education partnerships and how this can be achieved in a mutually beneficial way.

RELEVANCE TO CLINICAL PRACTICE

The development of quality improvement partnerships has been found to increase student knowledge and understanding, potentially improving patient outcomes, systems performance and professional development. More research is required on the establishment of quality improvement partnerships and the benefit these collaborations have on students, staff and patients.

Effects of a Self-Directed Clinical Practicum on Self-Confidence and Satisfaction with Clinical Practicum among South Korean Nursing Students: A Mixed-Methods Study

In self-directed learning, students take the initiative to identify learning goals, choose learning strategies, and evaluate learning outcomes. This study aimed to explore the effects of a self-directed clinical practicum on nursing students' self-confidence and satisfaction with the clinical practicum. This mixed-methods study used a non-equivalent control group with a pre- and post-test quasi-experimental design and content analysis. Participants were 111 nursing students (experimental group = 55, control group = 56). Quantitative (self-confidence and satisfaction with the clinical practicum) and qualitative (reflective diaries) data were collected. The experimental group had significantly increased scores for self-confidence and satisfaction with the clinical practicum compared with the control group. Four themes regarding the experience of the self-directed clinical practicum were identified: perceived linking of academic knowledge and practice, perceived development of nursing competency, enjoying the clinical practicum, and establishing nursing identity as a student. The self-directed clinical practicum developed as part of this study was found to be an effective education method for nursing students.

Change management experiences of nursing students in clinical practice: A phenomenological study

BACKGROUND

In healthcare services, nurses' roles and practices make them an integral component of the change process. Therefore, nurses should prepare for their change-creating roles during their education. However, little research regarding change management and the change creation process of nursing students is found in the literature.

OBJECTIVES

To identify the needs of undergraduate nursing students when initiating change in practice and to reveal their experiences during the planning and implementation process of change projects.

DESIGN

A descriptive, qualitative design using focus group was conducted.

PARTICIPANTS

The study includes third-year undergraduate nursing students enrolled in a nursing school in Turkey and were enrolled in the Management in Nursing and Clinical Practices courses.

METHODS

Six focus group were conducted with a total of 28 nursing students. Data were collected over one semester via a semi-structured form. The data were analyzed using thematic content analysis.

RESULTS

Regarding the change management experiences of the participants, five main themes ("changing world, changing necessities," "view from the perspective of change," "discovering resistance," "developing motivation against resistance," and "change in the perception of change"), and nine sub-themes were determined.

CONCLUSIONS

As a result of their change management experiences, nursing students might better contribute to the quality of patient care, think more critically and have more autonomy. Therefore, change process management should be extensively included in nursing education and should be systematically monitored.

Theory in quality improvement and patient safety education: A scoping review

INTRODUCTION

Theory plays an important role in education programming and research. However, its use in quality improvement and patient safety education has yet to be fully characterized. The authors undertook a scoping review to examine the use of theory in quality improvement and patient safety education.

METHODS

Eligible articles used theory to inform the design or study of a quality improvement or patient safety curriculum. The authors followed scoping review methodology and searched articles referenced in 20 systematic reviews of quality improvement and patient safety education, or articles citing one of these reviews, and hand searched eligible article references. Data analysis involved descriptive and interpretive summaries of theories used and the perspectives the theories offered.

RESULTS

Eligibility criteria were met by 28 articles, and 102 articles made superficial mention of theory. Eligible articles varied in professional group, learning stage and journal type. Theories fell into two broad categories: learning theories (n = 20) and social science theories (n = 11). Theory was used in the design (n = 12) or study (n = 17) of quality improvement and patient safety education. The range of theories shows the opportunity afforded by using more than one type of theory.

DISCUSSION

Theory can guide decisions regarding quality improvement and patient safety education practices or play a role in selecting a methodology or lens through which to study educational processes and outcomes. Educators and researchers should make deliberate choices around the use of theory that relates to aspects of an educational program that they seek to illuminate.

An integrative review of simulation, senior practicum and readiness for practice

Readiness for practice (RFP) is essential as new nurses will practice in a nursing shortage climate, with high acuity patients and complex technology. Nurse educators are challenged to foster readiness for practice.

AIM

The aim of this integrative review was to explore the impact of simulation and senior practicum on graduating senior nursing students' readiness for practice.

BACKGROUND

Readiness for practice has been a point of concern for healthcare for quite some time. This has led to a need for better understanding for what RFP means including their perceptions of various stakeholders. Further, it is important to address what teaching and learning strategies can be implemented to assist in ensuring the graduating senior nursing student is ready for practice on graduation and for their first professional practice. Readiness for practice is defined as the ability to safely and competently care for patients by synthesizing theory, skills, attitudes and values in applying clinical reasoning in practice settings.

METHOD

An integrative review identified 48 published papers on simulation and senior practicum that met the inclusion criteria.

RESULTS

Themes identified from the senior practicum/preceptor literature included clinical reasoning, skills, barriers to the senior practicum and transition. Themes identified regarding simulation as a strategy included preparation, competence development, clinical reasoning and the number of human patient simulators used.

CONCLUSION

Although the evidence is not conclusive, simulation and senior practicums have the promise of preparing graduating nursing students for their first professional practice. However, nurse educators must ensure simulations are well-organized with clear objectives and that preceptors are supported in teaching and assessing students.

Level of clinical reasoning in intermediate nursing students explained by education year and days of internships per healthcare branches: A cross - sectional study

BACKGROUND

Due to changes in health care nurses are achieving more responsibilities. Globally nurses are trained at different educational levels to become registered nurses. All nurses should be able to implement clinical reasoning in chronic and acute patient care. There is uncertainty in health care institutes about the level of performance of clinical reasoning in the intermediate nurses.

OBJECTIVES

This cross-sectional study aimed to assess the level of clinical reasoning in intermediate nursing students in different education years. Furthermore, we explored whether the level of clinical reasoning can be explained by years of education and numbers of internship days in different healthcare settings.

DESIGN, SETTING AND PARTICIPANTS

All second, third and fourth year (n = 151) nursing students of one nursing school in the Netherlands were invited to participate in this study. Levels of clinical reasoning were assessed using the Dutch Lasater Clinical Judgment Rubric (D - LCJR).

METHODS

Twelve experienced nurses assessed the students during two days at the beginning of their education year in an educational simulation setting. Following the assessment protocol, the Rubric was scored in an interview after the students saw their patient.

RESULTS

We assessed 119 students. Fourth-year students scored on a significant higher level of clinical reasoning compared to the second - and third-year students (p < 0.001). Forty five percent of them reached an accomplished level of clinical reasoning. Second- and third-year students scored similar in their level of clinical reasoning (p = 0.61). In addition to education year an internship in the hospital care also explained the variation in level of clinical reasoning. Together they explained 38% (p < 0.001).

CONCLUSIONS

Intermediate nursing students were successfully assessed on their level of clinical reasoning in an education environment. The level of clinical reasoning could be explained by education year and number of days internship in the hospital care.

Planning and implementing quality improvement projects in clinical practice: Third-year nursing students' learning experiences

AIMS AND OBJECTIVES

To evaluate the impact of an educational design to develop nursing students' competence to work systematically with quality improvement in clinical practice.

BACKGROUND

Competence in how to improve the quality and safety of healthcare services based on new knowledge is crucial for healthcare quality. Nursing education should give students opportunities to engage in quality improvement projects to gain this competence.

DESIGN

This project qualitatively evaluated the impact of the course on students' ability to plan and implement a quality improvement project in their clinical placement.

METHODS

Data from retrospective focus group interviews and written project reports were analysed by means of qualitative content analysis. Fifty-five students participated in the study. COREQ reporting guidelines were used.

RESULTS

Three themes were derived from the analysis: (a) the importance of anchoring the quality improvement project in the clinic; (b) experiencing the steps of a quality improvement project; and (c) challenging student role.

CONCLUSIONS

Course design that facilitates student-run small-scale quality improvement projects under supervision can enhance nurse students' competence in quality improvement work, as well as raise the students' awareness of the responsibility they will undertake as future nurses.

RELEVANCE TO CLINICAL PRACTICE

Nursing students work on quality improvement project in clinical placement may enhance their awareness and competence in developing quality and safety of healthcare services as future nurses.

Developing and sustaining nurses' service improvement capability: a phenomenological study

BACKGROUND

Service improvement to enhance care quality is a key nursing responsibility and developing sustainable skills and knowledge to become confident, capable service improvement practitioners is important for nurses in order to continually improve practice. How this happens is an under-researched area.

AIM

A hermeneutic, longitudinal study in Northern England aimed to better understand the service improvement lived experiences of participants as they progressed from undergraduate adult nursing students to registrants.

METHOD

Twenty year 3 student adult nurses were purposively selected to participate in individual semi-structured interviews just prior to graduation and up to 12 months post-registration. Hermeneutic circle data analysis were used.

FINDINGS

Themes identified were service improvement learning in nursing; socialisation in nursing practice; power and powerlessness in the clinical setting; and overcoming service improvement challenges. At the end of the study, participants developed seven positive adaptive behaviours to support their service improvement practice and the 'model of self-efficacy in service improvement enablement' was developed.

CONCLUSION

This study provides a model to enable student and registered nurses to develop and sustain service improvement capability.

Clinical placement anxiety in undergraduate nursing students: A concept analysis

OBJECTIVE

The primary aim of this review was to complete an in-depth analysis of clinical placement anxiety in undergraduate nursing students. Our overall goal was to establish a strong foundation for clinical education strategies and future research on clinical placement anxiety in nursing education.

DESIGN & METHODS

We utilized Walker and Avant's systematic 8-step approach to concept analysis as a framework to develop a comprehensive understanding of clinical placement anxiety in undergraduate students.

DATA SOURCES

A review of existing literature on clinical placement anxiety was conducted using the electronic databases of PubMed, CINAHL, and PsychInfo, as well as a grey literature and snowball search. Search terms included clinical placement, clinical experience, nursing students, undergraduate nursing students, and anxiety.

RESULTS

The literature search resulted in 81 articles that met the inclusion criteria. Five defining attributes were identified: a vague or unknown threat, psychological-emotional responses, psychological-cognitive responses, physiological responses, and unfamiliar environments or situations. Antecedents, consequences, and empirical referents of the concept were also highlighted.

CONCLUSIONS

Insights gleaned from this concept analysis may enhance the ability of clinical nursing educators to effectively prevent and manage student anxiety in the clinical setting. By contextualizing anxiety, we have also validated the importance of further exploration of the anxiety experienced by undergraduate nursing students during their clinical experiences. Thus, this concept analysis establishes the foundation for educational strategies, as well as future research in nursing education.

A mapping review of models of practice education in allied health and social care professions

Introduction

Practice education is fundamental to pre-registration learning for many health and social care professions, yet finding sufficient opportunities for students is challenging. One-to-one student–educator pairings are common, and while different models could increase placement opportunities, the associated terminology is inconsistent and an overview of advantages, challenges and available evidence is missing. This mapping review identifies, categorises and critically considers the evidence for different models of practice education used by health and social care professions.

Method

Papers from 2008 onwards reporting on practice education approaches in allied health or social care profession courses were identified in three databases. Data was extracted, methodological quality categorised and a typology of practice education models developed.

Findings

Fifty-three papers were reviewed and developed into a typology of 14 models. Mapping indicated issues with a lack of high-quality research and limitations in available outcome indicators. Pre-requisites for the effective operation of different models include preparation, communication and allowing sufficient time for new ways of working.

Conclusions

Practice education discourse is characterised by varied terminology and practices. Various models for structuring practice education exist, though the evidence for their effectiveness and impact on capacity is limited. Using consistent language and considering wider impacts and outcomes is recommended in future study.

The effect of replacing 1 week of content teaching with an intensive simulation-based learning activity on physiotherapy student clinical placement performance

BACKGROUND

Simulation-based learning (SBL) activities are increasingly used to replace or supplement clinical placements for physiotherapy students. There is limited literature evaluating SBL activities that replace on-campus teaching, and to our knowledge, no studies evaluate the role of SBL in counteracting the negative impact of delay between content teaching and clinical placements. The aims of this study were to (i) determine the effect on clinical placement performance of replacing 1 week of content teaching with a SBL activity and (ii) determine if a delay between content teaching and clinical placement impacted clinical placement performance.

METHODS

This study is a retrospective cohort study. Participants included students in the first two clinical placements of a graduate-entry, masters-level program. Six hundred twenty-nine student placements were analysed-285 clinical placements where students undertook a 20-h SBL activity immediately prior to clinical placement were compared with 344 placements where students received traditional content. Of the placements where students received the SBL, 147 occurred immediately following content teaching and 138 had a delay of at least 5 weeks. Performance on clinical placement was assessed using the Assessment of Physiotherapy Practice (APP).

RESULTS

There was a significant main effect of SBL with higher APP marks for the experimental group (3.12/4, SD = 0.25 vs 3.01/4, SD = 0.22), and post hoc analysis indicated marks were significantly higher for all seven areas of assessment. Students whose placements immediately followed content teaching performed better on mid-placement APP marks in two areas of assessment (analysis and planning, and intervention) compared to students for whom there was a delay. There were no statistically significant differences in relation to delay for end of placement APP marks.

CONCLUSION

Replacing 1 week of classroom teaching with a targeted, SBL activity immediately before placement significantly improved student performance on that clinical placement. A negative impact of delay was found on mid-placement, but not the end of placement APPs. Findings of improved performance when replacing a week of content teaching with a targeted SBL activity, and poorer performance on mid-placement marks with a delay between content teaching and clinical placement, may have implications for curriculum design.

Strengthening universal health: development of a nursing and midwifery education quality improvement toolkit

Objective:

to present the development of a toolkit for education quality improvement in universal health and primary health care, targeting schools of nursing and midwifery in Latin American and Caribbean countries.

Methods:

an expert work group conducted a systematic literature review, selected key content and completed toolkit drafting, using an iterative consensus approach. International partners reviewed the toolkit. Cognitive debriefing data were analyzed, revisions and new tools were integrated, and the final version was approved.

Results:

twenty-two articles were identified and mapped as resources. The Model for Improvement, a data-driven approach to performance analysis, was selected for its widespread use and simplicity in carrying out the following steps: 1) organize a team, 2) assess improvement need regarding universal health and primary health care education, 3) set an aim/goal and identify priorities using a matrix, 4) establish metrics, 5) identify change, 6) carry out a series of Plan-Do-Study-Act learning cycles, and 7) sustain change.

Conclusions:

the Education Quality Improvement Toolkit, developed through stakeholder consensus, provides a systematic, and potentially culturally adaptable approach to improve student, faculty, and program areas associated with universal health coverage and access.

An evaluation of approaches used to teach quality improvement to pre-registration healthcare professionals: An integrative review

BACKGROUND

Improving the quality of healthcare remains central to UK and international policy, practice and research. In 2003, The Institute of Medicine's 'Health Professions Education: A Bridge to Quality', advocated quality improvement as a core competency for all healthcare professionals. As a result, developing capacity and capability of those applying improvement methodologies in the pre-registration population has risen, yet, little is known about the teaching approaches employed for this purpose.

OBJECTIVES

To describe and analyse educational approaches used to teach quality improvement to pre-registration healthcare professionals and identify enabling and impeding factors.

DESIGN

Integrative review.

DATA SOURCES

CINAHL, PsychINFO, MEDLINE, ERIC, ASSIA, SCOPUS and Google Scholar were accessed for papers published between 2000 and 2016.

REVIEW METHODS

Publications where quality improvement education was delivered to pre-registration healthcare professionals were eligible. One author independently screened papers, extracted data using a modified version of the Reporting of Primary Studies in Education Guideline and evaluated methodological quality using the Weight of Evidence Framework. The Kirkpatrick Education Evaluation Model was used to explore the impact of teaching approaches. Enabling and impeding factors were thematically analysed. A narrative synthesis of findings is presented.

RESULTS

Ten papers were included, representing nursing, pharmacy and medicine from UK, Norway and USA. Studies comprised four quantitative, four mixed method, one qualitative and one cluster randomised trial, all allocated medium Weight of Evidence. Teaching approaches included experiential learning cited in all studies, didactics in seven, group work in four, seminars in three, self-directed learning in three and simulation in one. Most studies measured Level 1 of the Kirkpatrick Model (reaction), all but one measured Level 2 (skills, knowledge or attitudes), none measured Level 3 (behaviour) and one measured Level 4 (patient outcomes). Enabling and impeding themes included: Teaching Approaches, Clinical/Faculty support, Information Provision, Curriculum Balance and Data.

CONCLUSIONS

Evaluating quality improvement education is complex. Experiential learning combined with didactics is the favoured approach; however, attributing causality to educational intervention proves difficult in light of poor methodological rigour, lack of validated tools and complex clinical settings. Clarity regarding which quality improvement competencies are priority for this population would be useful to streamline future educational development and evaluation. Stronger collaboration between educators and clinicians is recommended to explore the multiple components and contextual factors associated with quality improvement education in practice. Ethnographic enquiry may be a logical next step to advance knowledge within the field.