In pursuit of an optimal model of undergraduate nurse clinical education: An integrative review

Nursing students' perceptions of inadequate nurse staffing in the clinical learning environment - a systematic narrative review

AIM

The aim of this study was to substantiate the perceptions and experiences of nursing students related to nurse understaffing in the clinical learning environment.

BACKGROUND

The quality of the clinical learning environment affects students' learning experiences, shapes their thinking about the profession and can influence their choice to stay or leave the profession. Understaffing in the clinical learning environment has an adverse impact on patient safety, quality of care outcomes and mortality. Understaffing has an impact on students' learning by reducing the quality of supervision and mentoring.

DESIGN

A systematic narrative review.

METHODS

Databases of Academic Search Premier, MEDLINE, Psychology and Behavioural Sciences, APA PsycINFO, APA PsycArticles, CINAHL, AMED were searched systematically. The review was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The reviewers independently conducted study selection, quality appraisal and data extraction. Quality appraisal was performed using the Mixed Methods Appraisal Tool (MMAT). Thematic analysis was used to synthesise the findings.

RESULTS

A total of eight research papers were included. Four themes were identified: inadequate support, feeling unprotected, being seen as a cover for staff shortages on shifts and patients ultimately suffer the consequences of understaffing.

CONCLUSIONS

This review revealed that understaffing in the learning environment meant that optimum level of supervision could not be provided, making students feel vulnerable and insecure, students felt unwelcome and used as cover for staff shortages. We recommend further examination of understaffing to inform policy for improvement in student-staff ratio, supervision and facilitation of learning.

Bridging the experience-complexity gap with longitudinal clinical placements

BACKGROUND

Clinical learning is a critical element to prepare nursing students for the profession. There is limited evidence on the experience-complexity gap among novice nursing students entering the workforce.

PURPOSE

This study aimed to implement a novel longitudinal clinical experience program and examined readiness for practice for undergraduate nursing students.

METHODS

We used a prospective cohort design using the Casey-Fink Readiness for Practice survey.

FINDINGS

There have been 2,004 clinical placements filled since the start of the program. Repeated exposure at one organization provided consistency and continuity while allowing students to develop relationships with patients and staff in a variety of settings. The medical-surgical two clinical experience was a pivotal course that influenced students' perception to enter the nursing workforce.

DISCUSSION

Clinical and academic partners must collaborate to provide the necessary competencies required to enter the workforce. Longitudinal clinical programs may improve nursing students readiness for practice.

CONCLUSION

The continous and immersive nature of the longitudinal clinical experience program facilitated the development of critical thinking skills and clinical competence, suggesting that longitudinal clinical placements can bridge the experience-complexity gap in nursing education.

Development of the Hybrid Clinical Practicum Environment Scale for Nursing Students

PURPOSE

This study aimed to develop a Hybrid Clinical Practicum Environment Scale for Nursing Students (HCPES-NS) and verify its validity and reliability.

METHODS

The HCPES-NS was constructed following the DeVellis guidelines. The initial items were written based on a literature review and individual in-depth interviews. Content validity was verified through an expert panel review. To confirm the validity and reliability of the scale, a survey was conducted with 449 nursing students enrolled in 12 nursing colleges. Data were analyzed using item analysis, exploratory factor analysis, confirmatory factor analysis, concurrent validity, and reliability tests.

RESULTS

Factor analysis showed that the HCPES-NS consists of 15 items on five subdomains: clinical site atmosphere, interpersonal relationship, alternative online practicum contents, provision of learning information, and clinical performance facilitation. A higher score indicated a more positive perception of the clinical practicum environment. The concurrent validity of the HCPES-NS was confirmed by its positive correlation with the Clinical Learning Environment Scale (r = .77). The Cronbach's α reliability of the HCPES-NS was .84.

CONCLUSION

The HCPES-NS is both valid and reliable. This scale reflects the clinical practicum environment and includes an online practicum factor. It may be used effectively by faculty members and educators to evaluate nursing students' perceptions of clinical practicum environments.

Nursing students' metaphors of first clinical experiences of encountering patients with mental disorders

BACKGROUND

Psychiatric wards are one of the most stressful medical centers. Apprenticeship in mental health can cause feelings of stress and anxiety among nursing students. Investigating nursing students' beliefs about mental illnesses is very important to improve nursing education. The present study aimed to identify nursing students' metaphors for their first clinical experiences of encountering patients with mental disorders.

METHODS

This descriptive qualitative study was conducted on 18 undergraduate nursing students studying in two nursing colleges at Guilan University of Medical Sciences, in the north of Iran, in 2022. The data were collected through semi-structured interviews and analyzed using Critical Metaphor Analysis by the MAXQDA 2007 software.

RESULTS

The analysis of nursing students' metaphors led to the emergence of 36 metaphors and 5 categories. These categories were "experience of dealing with a mental patient is similar to fear mixed with excitement", " patient is similar to an errant human", " psychiatric hospital is similar to a prison", "nurse is similar to a prison guard", and "clinical instructor is similar to a supporter, sympathetic and knowledgeable friend".

CONCLUSIONS

The results showed their negative attitude towards the psychiatric hospital and health care providers. It is suggested that the findings of this study be taken into consideration in the planning of clinical education of nursing students.

Measuring changes in nursing students' workplace performance following feedback encounters: A quasi-experimental study

BACKGROUND

Work-integrated learning and performance is intimately linked with assessment and feedback; however, empirical evidence concerning the impact of feedback on student performance in workplace settings is limited. A novel practice-based feedback intervention-the REMARK (nuRse fEedback iMplementAtion frameworRK) program-was developed and implemented. Sustainable feedback processes that involve both learners and learning partners can ultimately maximise learning outcomes, optimise self-regulation, and impact performance.

OBJECTIVES

To determine the impact of implementing an educational intervention based on best practice principles of feedback on undergraduate nursing student performance during clinical placements in acute healthcare settings.

METHODS

A non-equivalent, quasi-experimental design was used. A pre- and post-assessment strategy for both control and intervention groups was employed. The REMARK program was based on known attributes of effective feedback critiqued in the literature that foster interactions between a learner and learning partner and, hence, support dialogic feedback.

RESULTS

Clinical assessment data of 214 final-year nursing students collected at three time points were analysed. Using multivariate modelling, the results indicated that students participating in the REMARK programme (intervention group) had statistically higher performance scores than students in the control group when time and placement setting were controlled.

CONCLUSIONS

This research provides evidence that engagement with an intervention based on attributes of effective feedback improves nursing students' workplace performance during clinical placement. To achieve the greatest advantage, incorporating strategies that encourage students to adopt an active role in feedback conversations that relate to the student's learning goals are recommended.

A scoping review of clinical skill development of preregistration registered nurses in Australia and five other English-speaking countries

AIM

The aim of this scoping review is to synthesise current evidence around the clinical skill development of preregistration registered nurses (RNs) in Australia, United Kingdom (UK), Ireland, United States (US), Canada and New Zealand, to inform nurse education, policy and clinical practice.

BACKGROUND

Nursing is a practical profession, and registered nurses require specific skills, knowledge and attributes in order to care for patients safely. The context for health care delivery is shifting, and the education of nurses must adapt to effectively equip the registered nurse of the future.

DESIGN

A scoping review was conducted of clinical skill development in preregistration nurses. CINAHL Plus, MEDLINE, Health Source (Nursing/Academic edition) and Scopus were searched. Included studies were primary Australian studies and international literature reviews, which focussed on preregistration nursing education. Papers were written in the English language and focussed on clinical skill development. Results were synthesised narratively. The review is reported here in accordance with the Preferred Reporting Items for Systematic Review and Meta-analyses Scoping Review extension (PRISMA-ScR) guidelines.

RESULTS

One hundred fifty-five Australia studies and 89 international reviews were included in the review. Six key themes were identified, namely clinical skills, approaches to teaching and learning, interprofessional education, assessment of learning, clinical placement and simulation.

CONCLUSION

There is substantial variation in strategies and programmes to facilitate clinical skill development both within Australia and internationally, indicating a genuine shift away from traditional didactic pedagogy. New graduate registered nurses were expected to be "work-ready," albeit at a novice level, when they enter the workplace. Future research should consider measures of impact on actual clinical practice and focus on developing work-ready graduates for the range of clinical settings in which they may practice. Educators, policymakers and educational institutions can use these findings to inform curriculum developments to ensure that clinical skill development is evidence-based.

Undergraduate Supervised Clinical Practicum Activities: An Enlightening Exploration

BACKGROUND

Clinical nursing practice is the hallmark of nursing education providing for the application of nursing knowledge to the care of patients in a contextual clinical environment. There is no universal method for educating students in the clinical arena. The literature has been limited to the evaluation of clinical education models and student perceptions of learning; however, there is a gap in the literature regarding the daily clinical activities of faculty and students.

METHOD

This exploratory descriptive study examined the explicit undertakings of a clinical day among faculty and students in the southeastern United States.

RESULTS

Responses from 61 survey participants described detailed activities of a clinical day including preclinical preparation, prebriefing, student and faculty clinical activities, and postconference structure.

CONCLUSION

This foundational knowledge provides insight for improving clinical education with the goal of educators connecting clinical activities to the development of student competencies. [J Nurs Educ. 2022;61(10):591-593.].

Improving Active Collaborative Clinical Learning Through a Mobile Application for Undergraduate Nursing Students

Innovative teaching and learning strategies in pediatric clinical education are needed to ensure that learning outcomes are achieved efficiently and to improve students' satisfaction with the learning process. We developed a mobile application to enhance the clinical learning of nursing students during pediatric clinical practice and explored the participants' perceptions of the learning method. A mixed-method design and an online survey were used to assess participants' perceived achievement of learning objectives and satisfaction with the clinical practicum. Focus groups explored the participants' experience of using the application. The overall achievement of learning outcomes was 4.1 out of 5, and participants reported high satisfaction with the clinical practicum using the mobile application. Qualitative analysis of the transcripts revealed four major themes: (1) facilitation of collaborative learning through real-time interactions and communication; (2) engagement in active learning through an application; (3) a useful tool for enhancing critical thinking; and (4) the "curate's egg" nature of the application. The mobile application can be incorporated into the clinical education of nursing students to promote self-regulated learning and collaboration with faculty. Clear guidance on how to use the application in a clinical environment should be provided to students and preceptors to achieve better learning outcomes.

Pediatric practicums in undergraduate nursing programs: an integrative review

BACKGROUND

Practicum Placements are the signature andragogy used in undergraduate nursing programs to bring about knowledge consolidation. Little is known, however, about the types of pediatric practicum placements utilized by nursing programs to provide practical learning opportunities in child health to their students. The purpose of this integrative review is to identify and appraise existing literature on practical pediatric practices in undergraduate nursing education.

METHOD

Searches were conducted using the main relevant databases and search engines. Of the numerous articles retrieved, screened, and reviewed, 15 met the inclusion and exclusion criteria. Results were then analyzed using thematic analysis.

RESULTS

Two overarching themes were identified: (1) Adaptation, and (2) Learning.

CONCLUSION

Findings revealed that most nursing programs utilize alternative placement sites to meet the learning need of their students. These sites provided students with the opportunities to care for children and adolescents, and engage in a variety of health promotion and teaching activities.

Experiences of faculty and staff nurses working with nursing students during clinical placement in residential aged care facilities: a systematic review of qualitative evidence

OBJECTIVE

The objective of this review was to synthesize evidence on the experiences of faculty and staff nurses working with nursing students in clinical placement in residential aged care facilities.

INTRODUCTION

Nursing education helps prepare students to provide quality care to older adults. Nursing programs across the globe are championing the integration of content on the care of older adults into their curricula as well as recognizing the value of clinical placements that focus exclusively on this population. Staff nurses who work in residential aged care facilities often work alongside students. In this role, they can support faculty and mentor students. This review explored faculty and staff experiences of nursing student placements in such facilities.

INCLUSION CRITERIA

This review considered qualitative studies that address the experiences of faculty and staff nurses working with nursing students in residential aged care facilities. Studies published in English from 1995 onward were included.

METHODS

The literature search was conducted in CINAHL, MEDLINE, Embase, and ERIC. The search for unpublished articles included Proquest Dissertations and Theses and Google searches of the Canadian Nurses Association and American Nurses Association websites. Papers were screened by two reviewers independently against the inclusion criteria. Those meeting the criteria were appraised using the JBI critical appraisal checklist for qualitative research. Key findings from included studies were extracted using a standardized tool and classified as unequivocal, credible, or not supported. This review followed the principles of meta-aggregration in line with the JBI approach.

RESULTS

Six studies, published between 2001 and 2017, were included in the review. A total of 32 findings were extracted and aggregated into nine categories. From the nine categories, four synthesized findings were developed: i) students enhance the environment, whereby faculty and staff perceive that student presence enhances the residential aged care work and living environment, ii) effort is required by faculty and staff to make the experience work, reflecting a need for faculty and staff to accept and work with negativities, iii) residential aged care facilities provide rich learning experiences, indicating an appreciation for available learning opportunities, and iv) importance of a residential aged care-academic partnership for a collaborative approach in creating positive experiences for faculty and staff working with students in this setting.

CONCLUSION

Faculty and staff experiences highlight that residential aged care has the potential to provide students with valuable learning experiences, including how to provide comprehensive and quality nursing care to older adults. A lack of resources in residential aged care inspires faculty and staff to be creative in how they work with students. However, working with students can be challenging for faculty who lack interest and expertise in caring for older adults in this setting. Additionally, staff can become frustrated when they perceive that students do not value the learning opportunities that are available or do not appreciate the expertise required to work with older adults. Partnerships between residential aged care facilities and academic programs can ensure that faculty and staff have the support and resources required to optimize the clinical placements for students.

SYSTEMATIC REVIEW REGISTRATION NUMBER

PROSPERO CRD42020168698.

Learning on the periphery: a modified Delphi study of a nursing student communities of practice model

OBJECTIVES

To develop a contemporary student placement model to address current placement challenges, impact student learning, and alleviate supervisor burden.

METHODS

A modified Delphi technique was used to seek opinions, insights, and creative solutions.

RESULTS

A draft Communities of Practice placement model, based on a systematic literature review, was introduced to a heterogenous expert panel (n=12). A contemporary placement model was developed and refined via video conference and email over three rounds.

CONCLUSIONS

Despite initial reluctance concerning a new model, participants became conversant with the concept of peer-to-peer learning, where incidental, albeit essential, learning and support occurs between students, which also supports supervising staff. Greater flexibly and student screening were also incorporated to enable greater learning, confidence building, and reflection. The model's success is contingent upon students working within their scope of practice and provides a contemporary approach to best responds to student, education provider, and health service needs.

Student satisfaction level, clinical learning environment, and tutor participation in primary care clinical placements: An observational study

BACKGROUND

Competence evaluations in the clinical setting represent approximately 50% of the nurse training process. Factors, such as perceived learning environment and clinical nurse participation, may influence nursing student satisfaction during clinical placements.

OBJECTIVE

To evaluate the relationship between the levels of nursing student satisfaction with clinical placements, the clinical learning environment, and the level of nurse tutor participation.

DESIGN

A cross-sectional study.

SETTING AND PARTICIPANTS

We included 61 nursing students and 45 clinical nurses from 35 primary care centres assigned to the Universitat Jaume I.

VARIABLES AND DATA COLLECTION

We assessed the overall level of student satisfaction with clinical placements, students' perception of the learning environment, tutors' level of participation, and socio-demographic variables.

DATA ANALYSIS

We performed a descriptive analysis of the study sample, as well as correlation and simple linear regression analyses. Questionnaire results were analysed depending on the nature of the variables.

RESULTS

The students' perception of the learning environment was 4.39 ± 0.48 points out of 5. The overall satisfaction level was 8.89 ± 1.22 points out of 10. Tutor participation level in students learning was 3.91 ± 0.58 points out of 5.

CONCLUSIONS

Both student perception of the learning environment in the clinical setting and their overall level of satisfaction with clinical placements in the primary care centres were considered high. Tutors were participative, but poorly satisfied.

The Learning Environment of Student Nurses During Clinical Placement: A Qualitative Case Study of a Student-Dense Ward

Introduction

Ensuring the quality of clinical placements has long been a challenge in nursing education. This is partly due to a growing aging population requiring health services, and an increased need for nursing workforce. Both in Norway and internationally, there is a rise in the use of student-dense models, wherein several students are placed together on the same ward at the same time where the supervision of the students is the collective responsibility of the nurses.

Objective

The aim of this study was to explore factors that promote or inhibit learning in a student-dense ward when used as a model for clinical placement in hospitals. We examined how clinical placement is experienced in a student-dense ward, as well as how learning is facilitated.

Methods

A qualitative case study design was used to capture the learning environment on the student-dense ward in a comprehensive way. We used focus group interviews, in-depth interviews, and observations with students and employees at a major hospital in Norway.

Results

Our findings showed that the orientation days and the teaching activities in student-dense wards, the feedback students receive, the clinical facilitator's role and the student community were factors that had particular importance for good learning environments in this placement model.

Conclusions

To ensure the quality of clinical placements, more attention should be paid to these factors in the planning, organization, and facilitation of new and existing student-dense wards. It is paramount to provide students with thorough written feedback and to secure the clinical facilitators with enough time to conduct student supervision when organizing clinical placement as student-dense wards.

'Working as a Real Nurse': Nursing Students' Experiences of a Clinical Education Ward in Psychiatric Care

Although the concept of clinical education wards has shown encouraging outcomes regarding nursing students' satisfaction with clinical placements in somatic care, the existing research in a psychiatric context is sparse. This study aims to explore nursing students' experience during clinical education at a psychiatric clinical education ward. A qualitive descriptive study with content analysis, using interviews with 16 bachelor's degree nursing students was conducted. The results indicated that an enriched and adapted learning environment focusing on psychiatric nursing with peer learning supported independence and progression into the future nursing role.

An Evaluation of the Use and Effectiveness of Case Management in Clinical Nursing Education

Background

This study aims to evaluate the use and effectiveness of case management in clinical nursing education.

Methods

A sample of 181 nurses at the N3–N5 level were selected for clinical nursing education and divided into two groups using the random number method. The control group (n = 90) received traditional training, and the observation group (n = 91) received a case management model of training. The theoretical knowledge, nursing skills, training satisfaction, job stress, workplace mindfulness, career satisfaction, and job happiness of the two groups were compared. In addition, 50 patients were selected as subjects for each group, and their satisfaction with the nursing care that they received was also measured and compared.

Results

Theoretical knowledge and nursing skills scored higher in the observation group than in the control group (p < 0.05), and overall training satisfaction was higher in the observation group than in the control group (p < 0.05). After training, job stress in the observation group was lower than in the control group (p < 0.05), while workplace mindfulness, career satisfaction, and job happiness were higher in the observation group than in the control group (p < 0.05). In terms of nursing quality, on all indicators, the observation group scored higher than the control group (p < 0.05), and the patients’ nursing satisfaction scores were higher in the observation group than in the control group (p < 0.05).

Conclusion

Case management can improve the professionalism and overall skills of nurses at the N3–N5 levels. It is conducive to reducing job stress, enhancing workplace mindfulness, improving career satisfaction and job happiness, and improving the quality of nursing, thereby providing patients with better nursing care.

Health-promoting and -impeding aspects of using peer-learning during clinical practice education: A qualitative study

AIM

The aim of the present study was to elucidate health-promoting and -impeding aspects of peer-learning by examining nursing students' descriptions of learning together as peers, and how this might interact with their health.

BACKGROUND

Peer-learning is a useful strategy for teaching and learning in nursing students' clinical practice education. In the research, benefits such as improved cooperation and increased self-confidence have been described and labelled as health-promoting.

DESIGN

A qualitative descriptive approach METHOD: Thirteen first-year nursing students aged 22-45 years, who had completed their first clinical practice education on a medical or surgical hospital ward, participated in one-on-one semi-structured interviews. The interviews were analyzed using qualitative content analysis.

RESULT

Working as a pair was primarily described as positive, as the peers felt basic support from each other, even though they described negative experiences that limited their own development and challenged their patience.

CONCLUSION

Peer-learning as a model for supervision in clinical practice incorporates valuable health-promoting aspects, as the students felt safe, supported, increased self-confidence, and participation. The interaction between peers helped them grow as human beings, and the mutual support the peers felt was a vital health-promoting aspect that limited the impact of the described health-impeding aspects, which included sometimes finding peer-learning trying, stressful and irritating.

Whole of Community Facilitators: An Exemplar for Supporting Rural Health Workforce Recruitment through Students' Professional Experience Placements

The Whole of Community Facilitator model provides support for healthcare students’ professional experience placements (PEP) in rural regions in Tasmania. In Tasmania, rural PEP is challenged as healthcare facilities are often small and have limited capacity for staff to devote considerable time to supervising students during PEP. Recruitment and retention of the rural health workforce in Tasmania is sometimes difficult because the island State is geographically distant from mainland Australia, and predominantly classified as a regional, rural, or remote area. The University of Tasmania, College of Health and Medicine (the College) explored various initiatives to support rural workforce sustainability, and the project discussed addresses this issue by promoting rural healthcare facilities as potential employment destinations for students upon completion of their course. The model supports the delivery of high-quality supervision to students whilst undertaking rural PEP, to foster positive experiences and potentially influence their future career choices. A successful exemplar was trialled in 2012 and implemented statewide in 2017 using a Whole of Community Facilitation (WOCF) model. The initiative supports host facilities, supervisors, host staff, and students and promotes positive placement experiences. The initiative was designed in consideration of Tasmania’s rurality, and uses a flexible and responsive framework.

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.

Healthcare student-patient relationship and the quality of the clinical learning environment - a cross-sectional study

BACKGROUND

Relationships with patients are seen as the core component of establishing the quality of patient-centred care and promoting patients' autonomy and relevant use of services. A clinical learning environment that emphasizes relationship-based healthcare is essential for encouraging future healthcare professionals to work in partnership with patients. There is also broad agreement that the insight of patients should be used actively in healthcare students' clinical learning. The aim of this study was to describe healthcare students' perceptions of their relationship with patients and the quality of the clinical learning environment and to identify factors associated with both of these.

METHODS

A cross-sectional survey using an electronic questionnaire was applied to collect data from 1644 Finnish healthcare students, mostly nursing students, between January 2018 and May 2018. The data were analysed statistically using descriptive statistics, Spearman's correlation coefficients, and multifactor analysis of variance.

RESULTS

Students perceived the level of the student-patient relationship and the role of the teacher as good while pedagogical atmosphere, premises of care, premises of learning, and supervisory relationship were perceived to be at very good level. The correlations between the student-patient relationship and all clinical learning environment dimensions were perceived as moderate. Furthermore, a number of student-related factors associated with the student-patient relationship and the quality of the clinical learning environment were detected.

CONCLUSIONS

In this study, the rarely explored perspective of the student-patient relationship within the context of the clinical learning environment was included. The student-patient relationship and the quality of the clinical learning environment were perceived as good by the students, with a number of determining factors affecting these perceptions. Giving the student-patient relationship a role in clinical education may be conducive to students' learning with the patient in focus, and may thus promote the competence needed in the rapidly evolving healthcare environment and the changing scope of clinical practice.

Congruence between nursing students' and patients' views of student-patient relationships

The growing emphasis on learning with and from patients has shifted the focus from education and healthcare professionals to the student-patient relationship. The relationship between student and patient, with a supportive preceptor as a resource, can influence the progression and development of an authentic person-centred approach to care among students. The purpose of this study was to analyse the congruence between nursing students' and patients' views of their relationship during students' clinical placement. The study compared data from cross-sectional matched cohort pairs of nursing students (n = 187) and patients (n = 187) in Finland. The data were collected between March 2015 and May 2016 using corresponding questionnaires and procedures in both cases. Both students' and patients' views were moderately or weakly congruent in terms of facilitative relationship, characterised as a mutually enriching relationship for both students and patients through dialogue. Patients, however, tended to see the relationship significantly more often as mechanistic, focusing on students learning practical skills, compared to students who saw the relationship more often as facilitative. Patients' age and the reasons for care were the only background variables that predicted the congruence between students' and patients' views of their relationships. These findings suggest ways in which student-patient relationships can be made more meaningful in supporting learning in clinical education.

Clinical learning environment and graduating nursing students' competence: A multi-country cross-sectional study

The purpose of this study was to explore nursing students' perceptions of their final clinical learning environment and its association with their self-assessed competence, satisfaction with nursing education, and turnover intentions at graduation in six European countries. A multi-country comparative cross-sectional study was conducted with nursing students (n = 1746) from the Czech Republic, Finland, Italy, Portugal, Slovakia, and Spain using the Nurse Competence Scale and the Clinical Learning Environment and Supervision scale. Nursing students' overall perceptions of their final clinical learning environment and supervision were positive in all the countries studied. The correlation between the students' perceptions of their final clinical learning environment and competence was statistically significant and positive. Satisfaction with the nursing program and clinical practicum and no consideration of career change were related to positive perceptions of the final clinical learning environment. Highlighting the importance of the supervisory relationship and pedagogical atmosphere, nursing students' positive perceptions of the final clinical learning environment and supervision contribute to a better level of self-assessed competence and satisfaction with the nursing program and clinical practicum, leading to lower turnover intentions.

Supervisors' experiences of undergraduate nursing students' learning in clinical practice when applying caring and learning as parallel processes in a caritative caring conceptual learning model (Part 2)

The Model for Improvements in Learning Outcomes (MILO) is theoretically grounded and designed to intertwine didactics, pathophysiology and medicine with specific concepts important for learning. The aim was to describe supervisors' experiences of undergraduate nursing students' learning during clinical practice when using MILO. A qualitative and explorative design was used. Seventeen supervisors, thirteen women and four men from different departments at three hospitals in southern Sweden participated. After using the model, data were collected through four focus group interviews with open unstructured interview questions and analysed using inductive latent content analysis. Twelve subcategories, four generic subcategories and one main category emerged. The students developed a questioning approach and were more reflective, open and compliant. Twosomes enhanced learning. Specific documents generated structure and feelings of participation. The supervisors felt that taking the students' pre-understanding into account and a caring approach in the learning environment were valuable for enhanced learning. The students established a caring relationship with the patients and the patients' perspective became emphasized. Using MILO, intertwining between the natural and the professional became possible; enhanced learning in nursing skills together with a more caritative caring approach towards the patient was revealed. The need of compassion is discussed.

Undergraduate nursing student and preceptors' experiences of clinical placement through an innovative clinical school supervision model

This study explores final year undergraduate nursing and midwifery students and their preceptors' experiences of a newly introduced Clinical School Supervision (CSS) model, which was implemented to reduce a perceived disconnect between theory and practice. A descriptive design was used with qualitative data collected through open-ended survey questions. Respondents included 43 undergraduate nursing and midwifery students involved in the final year and 13 clinical preceptors from a large metropolitan tertiary health service in Victoria, Australia. Qualitative data were analysed using thematic analysis. Students described the CSS as a favoured supervision model with students being able to take advantage of support from both the academic supervisor and nursing staff in the clinical setting, a model which also supported student's sense of belonging. Students experiences indicated the CSS model facilitated consolidation of knowledge, reflective practice and transition to graduate nursing. The preceptors described a commitment to and preparedness for the role, although they found they had little break from teaching and their rosters did not always align with their students'. Preceptors also shared experiences of unfulfilled expectations, lack of recognition and incentives for supervising students. Further studies are needed to identify effective ways to support preceptors in their roles.

Nurses and undergraduate student nurses' experiences in collaborative clinical placement programs in acute hospitals: An integrative literature review

OBJECTIVES

To identify, and critically review student, nurse clinician and clinical facilitator/educator experiences of collaborative clinical placement models in acute hospitals.

DESIGN

An integrative review that followed Whittemore and Knafl's (2005) framework.

DATA SOURCES

Studies published between 2009 and 2019 were identified via a comprehensive search of the following databases: CINAHL, OVID Medline, EMBASE, EMCARE, PsychINFO, Johanna Briggs Institute, ERIC and SCOPUS.

REVIEW METHODS

The initial search located 2309 Articles. After screening and checking for eligibility 14 articles were critically appraised using the Critical Appraisal Skills Program checklist for qualitative papers, the McMaster's Critical Review Form for quantitative papers and MMAT Appraisal tool for mixed method papers. The papers were then analysed thematically.

RESULTS

Thirteen studies met the inclusion criteria for the review (four quantitative, six mixed method, three qualitative). We identified an overarching central theme of sense of belonging and acceptance along with the following four sub themes: familiarity and continuity, confidence and competence, preparedness and lastly supervising relationships and faculty support.

CONCLUSION

This review indicates collaborative clinical placement programs have a positive impact on the student experience. Further research is needed regarding experiences of clinical nurses, health organisation leaders and Faculty to better understand what will improve support of students in collaborative clinical placement programs as there were few research findings found related to these non-student participant groups. Exploring student placement experiences that include both traditional and Collaborative models would provide greater insight into the value of these programs.

Nursing student-patient relationship and related factors-A self-assessment by nursing students

AIMS AND OBJECTIVES

To describe the nursing student-patient relationship in terms of three types of relationships-mechanistic, authoritative and facilitative-and analyse the factors related to the type of relationship.

BACKGROUND

As future professionals, nursing students have a central role in facilitating patient autonomy while working in partnership with patients. Supporting student-patient relationship throughout the nursing education may result in positive outcomes for both students and patients.

DESIGN

A cross-sectional study.

METHODS

The data were collected from a convenience sample of Finnish nursing students using a structured web survey. Statistical data analysis was performed using chi-square test, two-sample t test, one-way analysis of variance and multinomial logistic regression. The STROBE Statement - Checklist for cross-sectional studies was used (Appendix S1).

RESULTS

Students most often assessed their relationship with the patients as facilitative, followed by authoritative and mechanistic relationships. The results revealed three predictors for facilitative relationship: students' older age, long enough contact time with the patient and higher competence in ensuring quality. In authoritative and facilitative relationships, students had significantly more positive perceptions of the contextual factors and consequences of the relationship and higher ratings of self-assessed competence levels than students in a mechanistic relationship.

CONCLUSIONS

It seems that the facilitative student-patient relationship is connected to the professional competence of nursing students, especially in the area of ensuring the quality of patient care. Therefore, sustaining clinical learning environments and pedagogical approaches that value and support facilitative relationships in students' clinical learning should be enhanced.

RELEVANCE TO CLINICAL PRACTICE

Efforts aimed at contributing to facilitative student-patient relationships have a crucial role in shaping students' competency and in promoting high-quality patient care. Thus, supervision of students organised around establishing mutual student-patient relationships with the preceptors acting as facilitators will benefit both students and patients.

The effectiveness of partnership models in clinical nursing education - A scoping review

OBJECTIVES

To examine the effectiveness of partnership models in clinical nursing education with regards to cost effectiveness; student employability, work-readiness, confidence, and competence; and stakeholders' satisfaction.

DESIGN

Scoping review.

DATA SOURCES

Research studies published in English were searched electronically through EbscoHost (CINAHL and ERIC), Scopus, Medline (via Ovid), ProQuest Central, and Web of Science databases. Criteria were developed to guide the selection of original studies published in English before 2019 for review.

REVIEW METHODS

Arksey and Malley's framework (2005) and relevant enhancements guided the conduct of the review. An informal appraisal of selected studies was applied.

RESULTS

Two theses and 31 articles with a variation in methodologies, methods, sample sizes, research populations and quality of evidence were included for review. Four themes were identified: (i) Description of partnership models in clinical education, (ii) length of model implementation prior to evaluation, (iii) positive qualitative findings, and (iv) quantitative findings limited by data collection periods and methods.

CONCLUSIONS

Shared among the reviewed studies is stakeholder view of the positive impacts of partnership models on the clinical learning environment, and the increased level of support and individualised instruction for students. However, the use of not fully validated survey instruments and the lack of description about the implementation period before evaluation in many reviewed studies limit the interpretation of quantifiable effect of the partnership models. This review identifies a lack of attention on student employability, work-readiness, cost evaluation, patient perspective, and partnership models in low-income countries. Future research to address these knowledge gaps using high quality data collection methods and rigorous research design is warranted.

Collaborative learning in practice: A systematic review and narrative synthesis of the research evidence in nurse education

Collaborative Learning in Practice is a model of placement learning for student nurses that is currently being implemented in the United Kingdom, apparently originating in Amsterdam. Potential benefits are reported to be increased placement capacity, reduced burdens on mentors as practice assessors, improvements in qualified nurses' job satisfaction, recruitment and retention, and better-developed preparedness for registrant practice amongst student nurses. We conducted a thorough, rigorous systematic review between October and December 2018 of the literature on Collaborative Learning in Practice to discover whether there was a research evidence base for these claims. We found nothing published in English in peer reviewed journals. We found 14 related papers, although these were about the Dedicated Education Unit concept, and we have conducted a narrative synthesis of them. Key findings support the assertions related to Collaborative Learning in Practice, albeit in different models of placement learning. Further research is necessary with Collaborative Learning in Practice stakeholders including staff and students, and regarding patient care metrics, to demonstrate benefits or otherwise and until that research takes place potential gains remain unproven.

Challenges to the provision of clinical education in nursing

Objective: To outline and discuss the challenges inherent in providing clinical education for undergraduate nursing students.Design: Discussion paper.Discussion: The primary goal of undergraduate nursing education is the preparation of graduates able to function as newly registered nurses in acute hospital, primary care, continuing care and mental health settings. Clinical practice is a critical yet complex and challenging component of students' professional development.Conclusions: It is argued that different models for clinical learning are appropriate for different contexts and stages of student development. Nursing needs, however, to be fully cognisant of the importance of collaborative development underpinned by adequate funding and to be aware of the often invisible impacts of neoliberal policies and priorities on health and education.

The Point of View of Undergraduate Health Students on Interprofessional Collaboration: A Thematic Analysis

Interprofessional education (IPE) is essential to prepare future professionals for interprofessional collaboration (IPC). Learning together is essential for students because it is a way to understand the roles of other colleagues, improve their skills, knowledge, competencies, and attitudes to collaborate with the interprofessional teams. To explore how undergraduate students who attend IPE courses define IPC, a qualitative study using semistructured interviews followed by a thematic analysis was performed. Four main themes were identifed: IPC as a resource, requirements for IPC, emotions linked to IPC, and tutor's role to facilitate students' perception of IPC. Students considered IPE important to build IPC, where clinical placement tutors play a key role. The most important findings of the present study include the students' considerations about the importance of IPE when building their IPC definition and the key role played by the tutor during the placement in building IPC in clinical practice.

Preceptors' perspectives of an integrated clinical learning model in a mental health environment

Supervised clinical practice is an essential component of undergraduate nursing students' learning and development. In the mental health setting, nursing students traditionally undertake four-week block placements. An integrated clinical learning model, where preceptors mentor students on an individual basis, has been used successfully in the clinical learning environment. This flexible model provides the opportunity for students to work across morning, afternoon, night and weekend shifts. There is a need to improve the evidence base for a flexible model for students undertaking a mental health placement. The aim of this study was to understand preceptors' experience of, and satisfaction with, a mental health integrated clinical learning model. Focus groups were used to elicit the views of preceptors from a mental health service. Findings highlight the advantages and disadvantages of an integrated clinical learning model in the mental health setting. Participants suggested that students may benefit from flexible work arrangements, a variety of experiences and a more realistic experience of working in a mental health service. However, they found it challenging to mentor and evaluate students under this model. Most also agreed that the model impeded students' ability to engage with consumers and develop rapport with staff. The findings indicate the need to develop a placement model that meets the unique needs of the mental health setting.

Supervision and assessment: the new Nursing and Midwifery Council standards

In the UK, mentors of pre-registration nurses must achieve the stage 2 outcomes of the Nursing and Midwifery Council (NMC) ( 2008 ) standards to support learning and assessment in practice. Approval for new standards for student supervision and assessment was granted at the NMC meeting in March 2018 ( NMC 2018a ). The introduction of the new standards will see the dissolution of mentorship and the emergence of new roles to support students in academic and practice environments. This article gives an overview of these standards and, drawing on the recommendations from a collaborative event hosted by NHS Education for Scotland and some of the findings from a rapid literature review undertaken for that event, provides nurse managers with information to help inform their discussions as they work in partnership with approved education institution colleagues to realise, support and sustain the roles outlined in the new standards. The article concludes with some questions to consider during these collaborative discussions.

Predictors of nurses' level of participation in student care: A multivariable analysis

OBJECTIVE

To determine the association and predictive nature of certain socio-demographic, education, work and research variables on nurses' participation level in the clinical care of students.

DESIGN

A cross-sectional analytical study using a validated questionnaire between February and June 2014.

SETTING AND PARTICIPANTS

A consecutive sample of 117 nurses who worked in public health centres in the province of Castellón (Spain) in 2014. The nurses who had never mentored students and the questionnaires that were <50% complete were excluded.

METHODS

A descriptive analysis of the sample and an association analysis between variables were performed. The questionnaire and its dimensions were performed with a logistic regression and the maximum likelihood method, which used a complementary log-log link method. The concordance index was calculated using contingency tables.

RESULTS

The mean age was 42.56 years, and the overall mean questionnaire score was 122.84 (SD = 18.69; 95% CI: 119.415-126.26). Across the sample, 58.1% (n = 68) of the nurses obtained an Excellent score, followed by Adequate in 41% (n = 48). Overall, the predictive variables were age, mentoring of students in the last 5 years and previous training to mentor students.

CONCLUSION

The main predictive variable for greater participation in the mentorship of students was previous training in mentoring. This study also reflected on other variables that could influence nurses' participation in student mentoring.

Participation of clinical nurses in the practical education of undergraduate nursing students

OBJECTIVE

To evaluate the level of participation of clinical nurses from Castellón where Universitat JaumeI nursing students do their clinical clerkship. To identify the variables that may influence clinical nurses' participation in students' clinical mentorship.

METHOD

This observational, cross-sectional and descriptive study was conducted by applying the validated Involvement, Motivation, Satisfaction, Obstacles and Commitment (IMSOC) questionnaire. The variables collected were: age, work environment and previous training. The study was conducted between January and December 2014.

RESULTS

The sample included 117 nurses. The overall mean questionnaire score was 122.838 (standard deviation: ±18.692; interquartile range 95%: 119.415-126.26). The variable "previous training for mentorship students" was statistically significant in the overall score and for all dimensions (P<.05). Primary care nurses obtained better scores in the dimension Implication than professionals working at other care levels.

CONCLUSIONS

The level of participation of the clinical nurses from Castellón is adequate. The previous training that professionals receive for mentoring students improves both their level of participation and primary care level. Extending this research to other national and international environments is recommended.