Japanese nursing students' sense of belonging: A story of Uchi (insider) and Soto (outsider)

Defining sense of belonging in nursing - An evolutionary concept analysis

OBJECTIVES

The purpose of this analysis is to develop the concept of sense of belonging in nursing. The secondary purpose is to identify the antithesis or direct opposite beyond the negative consequences related to a lack of belonging in nursing.

DESIGN

Rodgers' evolutionary method guided the analysis and advancement of sense of belonging in nursing.

DATA SOURCES

Following PRISMA guidelines, peer-reviewed English articles and dissertations were reviewed from PubMed, ERIC, CINAHL, and PsychINFO. Forty-seven articles describing sense of belonging in the nursing profession, both academic and workforce, were included.

REVIEW METHODS

Inductive thematic analysis was used to determine recurring themes of the antecedents, attributes, consequences, and antithesis of belonging in nursing.

RESULTS

A welcoming, positive atmosphere encouraging a culture of mentorship is key to developing an environment of belonging. The attributes of belonging include being trusted, valued, and an accepted part of the team, and encouraging a connection to the community. Nurses and nursing students have improved confidence, self-esteem, and motivation to learn when a sense of belonging is present. They feel supported and respected in the environment. However, historically minoritized students and nurses report discrimination, bias, and condescension resulting in feeling invisible, isolated, excluded, and neglected. Nurses and nursing students feel invisible, isolated, excluded, and neglected without a sense of belonging.

CONCLUSION

Developing a sense of belonging in nurses and nursing students is critical to our profession. Further research is essential to develop interventions and strategies for cultivating a sense of belonging in nursing.

Modifiable factors contributing to belongingness of undergraduate nursing students in the clinical learning environment: An exploratory study

BACKGROUND

Belongingness has been tied to positive personal and educational outcomes in undergraduate nursing students in the clinical learning environment, but there is limited literature on specific factors that promote these important feelings of acceptance and value alignment.

OBJECTIVES

This study aimed to assess demographic characteristics, program/clinical structure factors, and modifiable clinical setting factors that may impact feelings of belongingness in U.S. undergraduate nursing students in the clinical learning environment.

DESIGN

A cross-sectional survey design was used to assess the relationship between demographics, program/clinical structure factors, and modifiable clinical setting factors and levels of belongingness using the U.S. version of the Belongingness Scale - Clinical Placement Experience.

SETTING

A national study was conducted via the National Student Nurses Association database from December 2022 to January 2023.

PARTICIPANTS

759 volunteer undergraduate nursing students in the U.S. who had completed at least one clinical course.

METHODS

An online survey was disseminated to assess demographic factors, program/clinical structure factors, students' perceptions on the frequency of occurrence and perceived value of modifiable clinical setting factors (including clinical format, clinical site, relationship and interpersonal, and miscellaneous factors), and to measure levels of belongingness experienced.

RESULTS

Bivariate analyses revealed one statistically significant program/clinical structure factor (p <.001) and 10 statistically significant modifiable clinical setting factors (p <.001) that contribute to belongingness. The findings also support the use of the U.S. version of the BES-CPE as a reliable and valid instrument.

CONCLUSIONS

Results demonstrate the importance of fostering belongingness in undergraduate nursing students in the clinical learning environment and, for the first time, extrapolate qualitative findings from the literature into the identification of factors that contribute to these critical feelings of inclusion. There are immediate implications for nursing educators and a rich foundation for future intervention research is proposed.

Modeling the social determinants of resilience in health professions students: impact on psychological adjustment

Stressors inherent to training and stemming from the learning environment are associated with high rates of burnout, depression, and mental health problems in health professions students (HPS). There is evidence that disadvantaged or stigmatized groups are particularly affected. These problems not only impact students after graduation but may also have detrimental effects on patient outcomes. Resilience, conceptualized as the process of adapting well in the face of adversity, has inspired an increasing number of interventions aimed at addressing those problems in HPS. These interventions have mostly targeted individual students and their psychological traits while ignoring social and structural factors that may enhance or undermine individual resilience. To address this gap in the literature, the authors reviewed the evidence for psychosocial determinants of resilience and proposed a model inspired by the social determinants of health literature and the "upstream-downstream" metaphor. In this theoretical paper, the authors propose that upstream determinants such adverse childhood experiences and socioeconomic and sociodemographic markers of disadvantage have a direct effect on psychological adjustment and an indirect effect mediated by resilience. Additionally, the authors propose that the institutional downstream drivers of learning environment, social support, and sense of belonging moderate the direct and indirect effects of the upstream determinants on psychological adjustment. Future research should test these hypotheses and gather evidence that may guide the development of interventions. The authors present their model as part of a comprehensive response to recent calls to action to address diversity, equity and inclusion in health professions education.

DEVELOPMENT AND PSYCHOMETRIC TESTING OF THE SENSE OF BELONGING IN NURSING SCHOOL SCALE

Background and Purpose: While sense of belonging is essential for human motivation, impaired belonging among nurses can impact the care and safety of patients. This article reports the development and psychometric testing of the Sense of Belonging in Nursing School (SBNS) scale to assess nursing students' sense of belonging in three different environments: Clinical, classroom, and among the student cohort. Method: Principal component exploratory factor analysis with varimax rotation was used to determine the construct validity on the 36-item SBNS scale with a sample of 110 undergraduate nursing students. Cronbach's alpha was used to determine the scale's internal consistency. Results: The scale was reduced to 19-items with high internal consistency (α = 0.914). Principal component analysis then identified four factors (sub-scales) with high internal consistency: Clinical staff (α = 0.904), clinical instructor (α = 0.926), classroom (α = 0.902), and classmates/cohort (α = 0.952). Conclusion: The SBNS scale is a reliable and valid tool to measure sense of belonging across three environments among nursing students. Further research is needed to determine the scale's predictive validity.

Belongingness in undergraduate/pre-licensure nursing students in the clinical learning environment: A scoping review

AIM

The aim of this scoping review was to map the literature investigating belongingness in undergraduate/pre-licensure nursing students in the clinical learning environment.

BACKGROUND

The concept of belongingness, which encompasses feelings of acceptance, connection and value alignment, has been tied to positive outcomes in undergraduate/pre-licensure nursing students including increased learning, participation, confidence and professional socialization. It is critical for educators and clinical staff to foster a sense of belongingness for nursing students to promote positive and effective clinical learning experiences.

DESIGN

The scoping review strategy established by the Joanna Briggs Institute was followed. The databases searched were CINAHL Complete (EBSCO), Education Source, Medline Complete (EBSCO), APA PsycINFO (EBSCO) and Epistemonikos.

METHODS

Following a search of the five databases, studies were screened by title and abstract by two independent reviewers for inclusion. Data including population, concept, context, methods and key findings relevant to the review question were extracted and synthesized using an instrument developed by the reviewers.

RESULTS

A total of 47 articles with varying methodologies were critically appraised. Three overarching focus areas emerged: outcomes resulting from feelings of belongingness versus alienation, factors that contribute to a sense of belongingness in the clinical learning environment and interventions to promote a sense of belongingness while students are immersed in the clinical learning environment.

CONCLUSIONS

Belongingness in the clinical learning environment is an important concept that lends itself to positive learning experiences and increased satisfaction of undergraduate/pre-licensure nursing students. Environmental, relational and experiential factors can be maximized and specific interventions employed to promote belongingness. This review identifies a lack of evidence on measured interventional effectiveness at the student, school and clinical unit level. Future research to address these gaps is recommended.

TWEETABLE ABSTRACT

Scoping review suggests environmental, relational and experiential factors promote positive outcomes in belongingness of nursing students.

Strategies to address structural and institutional barriers to success among students of color in nursing programs

The COVID-19 pandemic and the significant disparities experienced by Black, Indigenous, and people of color (BIPOC) in infections, hospitalizations, and deaths associated with the Coronavirus have underscored the imperative to increase the size and diversity of the healthcare workforce, including nursing. Academically focused pipeline development programs have led to some advances in minority recruitment and retention; however, emerging research highlights the importance of extra-academic factors that reduce the sense of belonging and persistence among underrepresented and minority students. The purpose of this manuscript is to describe the diversity, equity, and inclusion goals and activities of a college of nursing located in a minority-serving institution. Here, we emphasize the description of a range of activities aimed at meeting our diversity goals. Further, we highlight the actions initiated in response to emergent "extra-academic" student needs over the past year related to the COVID-19 pandemic and police brutality. The strategies described have implications for improving diversity, equity, and inclusion among higher education institutions in nursing.

Modification, Translation, and Psychometric Testing of the Arabic Version of the Belongingness Scale-Clinical Placement Experience (BES-CPE)

BACKGROUND

This paper aimed to describe the modification, translation, and psychometric testing of the Arabic version of the Belongingness Scale-Clinical Placement Experience (BES-CPE).

METHODS

This study included the following phases: modification of the original BES-CPE based on the qualitative findings from a previous study; translation and back-translation of the scale; evaluation of the content validity by experts from Saudi Arabia; evaluation of the internal consistency reliability; and other psychometric properties of the Arabic BES-CPE.

RESULT

The results demonstrated acceptable psychometric properties. The Cronbach's alpha ranged from 0.68 to 0.92.

CONCLUSION

The Arabic BES-CPE is a promising tool that can be used to assess Saudi nursing students' sense of belonging. However, testing the tool with other undergraduate nursing students in a different context is recommended.

Students' perceptions of belonging in the School of Nursing at a regional university in Australia

BACKGROUND

Attrition in pre-registration nursing degrees is a global issue. Students' perceptions of belonging is a factor that influences attrition.

OBJECTIVE

The objective of this study was to evaluate students' perception of belonging to a School of Nursing, as well as their intention to complete the pre-registration Bachelor of Nursing (BN) program following implementation of the Initiatives for Retention (IR) intervention.

DESIGN

A prospective cross-sectional survey of student nurses was undertaken using an online questionnaire.

SETTING

A large regional university in Australia.

PARTICIPANTS

Pre-registration nursing students.

METHODS

Perceptions of Belonging were evaluated using the 24-item Belonging questionnaire comprising three subscales. Data were analysed using SPSS version 25. Pearson's correlation, Student's t-tests and one way ANOVA were used to assess associations and differences in belonging scores and student demographics, study status and participation in the Initiatives for Retention (IR) intervention.

RESULTS

A total of 201 students responded to the voluntary questionnaire. The mean score for overall Belonging was 70.5 (maximum obtainable 96), mean Scores for University affiliation, University support and acceptance, and staff relations with students were 34.7, 24.1 and 11.8 respectively. Female students, those who were studying at the university for less than a year and those who participated in the IR intervention activities reported significantly higher University Belonging scores compared to their contemporaries. Logistic regression revealed that students studying the BN course for more than 3 years (OR: 0.43 95% CI 0.20-0.93, p = 0.031), and those employed (OR: 0.435, 95% CI 0.16-0.16, p = 0.022) were significant predictors of not attending the IR sessions. There were no significant differences in overall University Belonging scores based on other demographic characteristics and, study status. The majority of the students (84%) stated that they plan to continue and complete the BN program.

CONCLUSIONS

Measures designed to develop student involvement may positively contribute a successful relationship between the institution and the student, increasing the students' sense of belonging and decreasing attrition among student nurses.

PRACTICE IMPLICATIONS

Initiatives for Retention (IR) facilitate a greater sense of belonging in nursing students hence Schools of Nursing should consider embedding such strategies.

Wellness among nursing students: A qualitative study

Nursing students typically experience high levels of stress and anxiety in nursing schools, and this is often compounded by having to combine complex classroom theories with practice. Healthy behaviors are subsequently neglected, diminishing academic efficiency and personal wellbeing. Student nurses need to adopt healthy lifestyles since wellness has been shown to promote positive health outcomes. Nonetheless, studies on the perception of wellness, and descriptions of its facilitators and barriers in wellness promotion among nursing students remain limited. This qualitative descriptive study aimed to explore facilitators and barriers to promote wellness among nursing students in Thailand. Data was gathered using focus groups with 80 undergraduate third and fourth-year nursing students, comprising 64 females and 16 males. Four themes emerged from content analysis regarding the facilitators of promoting wellness: healthy living; belief in animism; self-optimism; and receiving support. Barriers to wellness were three themes of stressors involved in students' lives: pressure from instructors; behaviors of staff nurses; and being perceived as untrustworthy. It is vital to promote wellness among nursing students to encourage their health care choices and to support them through their studies.

Diabetes knowledge and perceptions among nursing students, and curriculum differences in Japan and Australia: A cross-sectional study

OBJECTIVES

To investigate the associations between knowledge and perceptions of diabetes mellitus (DM) among nursing students from Japan and Australia; and to compare curriculum differences.

RESEARCH DESIGN AND METHODS

Cross-sectional study. Convenience sample of students from Japan (N=78) and Australia (N=85) in their final year were surveyed. Students reported demographic details, and perceptions towards caring for patients with DM. The 23-item Michigan Diabetes Knowledge Test (MDKT) was used to assess general knowledge, and seven additional questions were used to assess DM-related clinical knowledge (CDKT). Multivariate logistic regression models were used to determine the associations between knowledge and perceptions. The curricula of the two universities were compared through a review of teaching hours on DM, teaching methods, class sizes and self-reported number of DM patients cared for during clinical placement.

RESULTS

Australian students were more likely to be aware of DM and identified caring for more patients on clinical placement during the course. They also performed better on the CDKT in comparison to the Japanese students (71.43% versus 65.02%). When teaching models were compared, the Japanese curriculum dedicated more hours to didactic classroom teaching on DM and had a smaller teacher to student ratio. While both groups felt they received enough classroom education on DM, the Japanese students self-reported lower perceived competency, self-confidence, and felt less prepared to care for DM patients. However Japanese students performed slightly better on the MDKT than Australian students (74.25% versus 70.03%). Being from Japan was a predictor for high MDKT score (>73.91%), while perceived preparedness was a predictor for high CDKT score (>71.43%).

CONCLUSIONS

Statistically significant differences in DM knowledge (CDKT score) between students were found. There remains room for improvement, particularly a need for increased teaching hours at University and greater clinical practice time caring for patients with DM, to further improve knowledge and skills.