Nursing students' learning dynamics and influencing factors in clinical contexts

'Clinical Is the Pinnacle': Nurse Academics' Perspectives and Opinions of Their Students Undertaking Mental Health Clinical Placements

Clinical placements form an integral and important part of preregistration nursing student learning. The theory-practice gap has been identified as problematic, with clinical experience being a key strategy to address this. Despite this, the perceptions of nurse academics teaching preregistration mental health nursing regarding clinical placements have not been widely explored. To garner perspectives and experiences of mental health clinical placements from nurse academics teaching mental health nursing to preregistration nursing students. A descriptive qualitative study involving 19 nurse academics from 13 metropolitan and regional Australian universities, who were involved in the design and delivery of preregistration mental health nursing content. Data were analysed thematically. The study adhered to the Standards for Reporting Qualitative Research (SRQR). Participants reported that inappropriate clinical placements generate negative student experiences. Furthermore, mental health placements in nonspecialist settings such as medical-surgical or aged care compromised student learning and posed a barrier to linking theory to practice. Increasing meaningful and appropriate mental health clinical placements in nurse education requires investment and support from multiple stakeholders. Nurse academics are crucial stakeholders in terms of understanding the impact of mental health clinical placements. Appropriate mental health clinical placements are central to effective comprehensive nurse education. Academics teaching mental health in preregistration curricula are significant stakeholders, and their informed perceptions are central to compel change.

Challenge or threat? A Q-methodological study into nursing students' perceptions on learning to collaborate under stress

INTRODUCTION

Nursing students will come across stressful situations during their internships and will continue to do so in future practice. Because of the impact stress can have on performance, nursing students need to be equipped to work and collaborate in such situations. Careful consideration of the needs and desires of nursing students should be taken in account, in order to create a training environment that fosters students' ability to learn to collaborate under stress.

AIM

The aim of this study is to identify viewpoints of undergraduate nursing students towards the learning of collaboration in stressful situations, to understand their needs and desires, and to improve educational designs for training to collaborate in stressful situations.

METHODS

We conducted a Q-methodology study, a mixed methods approach that studies and charts subjectivity, and uses a by-person factor analytical procedure to create profiles of shared viewpoints. The process of our Q-study is based on the following five steps: Q-set development (54 statements), participant selection (n = 29), Q-sorting procedure, data analysis, and factor interpretation.

RESULTS

Q-factor analysis resulted in two prevailing factors that answer our research question. Twenty-five students loaded on these two factors, and factor interpretation resulted in Profile 1 "Practice makes perfect, so let's do it" and Profile 2 "Practice is needed, but it scares me". Whereas Profile 1 regarded learning to collaborate in stress mainly as a challenge, Profile 2 appeared anxious despite feeling the necessity to learn this. An overarching consensus factor revealed the importance of a learning environment in which mistakes can be made.

DISCUSSION

The two described profiles align with the biopsychosocial model of challenge and threat, and could help to recognize and address the individual needs of nursing students when learning to collaborate in stressful situations. Incorporating these profiles in training may guide students towards a more challenge-like appraisal of stressful situations.

Physiotherapy students' rating on lecturers' and supervisors' clinical education attributes

Background

Clinical education is considered a vital aspect of education of health science students. Attributes of clinical educators play a crucial role in determining the outcome of clinical teaching and learning. A good clinical educator ensures that students get maximum benefits of the clinical learning experience.

Objective

To determine the ratings of physiotherapy students on clinical education attributes of lecturers and clinical supervisors.

Methods

The study was conducted with 81 clinical physiotherapy students from two universities in Ghana. Two copies of McGill clinical teachers' evaluation (CTE) tool were used to obtain students' ratings on their clinical supervisors' and lecturers' clinical education attributes. Independent t-test was used to compare the means of students' level of study and ratings regarding the clinical education attributes of clinical supervisors and lecturers.

Results

Students had a high rating on their clinical education attributes of supervisors and lecturers with a mean score of (121 . 22 ± 18 . 12 ) and (122 . 11 ± 16 . 71 ), respectively. Rating on clinical education attributes of supervisors (p = 0 . 111 ) and lecturers (p = 0 . 124 ) did not differ significantly between the different levels of study.

Conclusion

Clinical physiotherapy students rated the clinical education attributes of their lecturers and supervisors high.

Exploring nurse mentors' job crafting: A longitudinal study on missed nursing care across student supervision

AIM

To compare the job crafting strategies nurse mentors use when mentoring students versus during periods of respite and to assess the effectiveness of these strategies in reducing instances of missed nursing care (MNC).

BACKGROUND

Nurses who serve as mentors may have to train a group of nursing students on top of their routine nursing duties. The corresponding high workloads and limited resources may force them to decide which nursing care to delay or omit (i.e., MNC). The mentors' initiative and the actions they take to address the multiple job requirements which do not align with the organization's resources are referred to as job crafting strategies. Mentors can use these strategies to shape their role as nurses as well as their role as mentors, depending on their motives and personality.

DESIGN

A longitudinal study with data collected at two time points.

METHODS

One hundred nurse mentors completed validated questionnaires assessing job crafting strategies, MNC and work overload while actively mentoring students. Eighty returned for a follow-up during a non-mentoring period three months later. Data analysis included paired t-tests and hierarchical multivariable linear regressions.

RESULTS

No significant differences were found in MNC between the two points (1.83 SD 0.6 vs. 1.82 SD 0.75; p=0.942). A decrease in hindering demands was noted during active mentoring compared with respite (2.6 SD 0.97 vs. 2.84 SD 0.96; p=0.038). Enhancing structural job resources was significantly negatively correlated with MNC during active mentoring, while enhancing challenging job demands was positively correlated with MNC during these periods (β=0.48, p=0.18 and β=-0.35, p=0.014, respectively).

CONCLUSION

Nurse mentors can effectively reduce MNC by focusing on enhancing structural resources and limiting challenging demands during mentoring periods. It is essential for healthcare organizations to support nurse mentors with manageable workloads and necessary resources to maintain high-quality care.

Nurses, midwives and students' reports of effective dedicated education units in five European countries: A qualitative study

AIM

To investigate nursing/midwifery students, Clinical Mentors, Link Teachers and Head Nurses experiences within "Dedicated Education Unit" model in 6 European clinical placements and analyse the necessary elements for a powerful clinical learning environment.

DESIGN

A multi-country, phenomenological, qualitative study.

METHODS

Focus group interviews were performed to identify the personal and organizational factors of importance for students and nurses/midwives.

RESULTS

Data analysis produced 4 main themes (1) Clinical placement organization, (2) students' clinical knowledge and skill acquisition, (3) students, and nurses/midwives' experiences within the DEU model and (4) factors for creating an effective learning environment.

CONCLUSIONS

A close educational-service collaboration, a realistic clinical placement planning, a focus on student learning process and an investment in professionals' education and development among others, are elements to set up a powerful clinical learning environment.

IMPLICATIONS FOR THE PROFESSION

It is considered advisable and urgent to improve the working conditions of nurses/midwives and the learning environments of students as a strategy to alleviate the global shortage of nurses and respond to the increasingly demanding health needs of the population.

IMPACT

Due to the close relationship between students' learning and features of the clinical environment nurse educators seek innovative models which allow students to manage patient care and their transition to professional practice. To implement new learning strategies, identifying students, nurses and midwives perceptions and suggestions is a powerful information to evaluate implementation process and outcomes.

PUBLIC CONTRIBUTION

Our findings could help academic and clinical managers to meet the human and organizational requirements to create a successful learning environment in every student placement.

Strategies for enhancing Chinese students' engagement in a large class learning environment: An interpretative phenomenological approach

AIM

It is common for Chinese students to sit quietly during classroom lectures, attentively following teachers' instructions without interacting or asking questions, viewed as passive engagement. This study aims to understand further the passive engagement of Chinese students in relation to classroom questioning, just-in-time feedback and collaborative activities. With objectives to formulate strategies to enhance Chinese students' engagement in a large class learning environment without undermining the cultural dimension of "face".

BACKGROUND

Engaging in collaborative educational activities between teachers and students can be challenging in a large classroom learning environment. Within the Chinese context, Confucian-heritage culture may further exacerbate the challenges teachers face. Chinese students often appear passive when responding to questions. In this situation, educators may receive insufficient student feedback to modify and optimise their teaching and learning approaches.

DESIGN

A qualitative research method, with an interpretative phenomenological approach was employed in a self-financed institute of higher education in Hong Kong.

METHODS

Eight nursing graduates were invited to participate in two focus group interviews to generate teaching and learning strategies. In addition, individual in-depth interviews were conducted with twelve nursing teachers recruited through a snowballing sampling strategy. The narratives were coded, categorised, themed, analysed and interpreted through thematic analysis.

RESULTS

Chinese students are concerned with "losing face" and the fear of being teased by their peers in a collectivist culture. Based on these findings, three teaching and learning strategies for engaging students in classroom questioning and collaborative activities were generated. These strategies include using digital learning platforms, the promotion of communication and fostering interpersonal relationships.

CONCLUSIONS

In higher education, academic managers and teachers must critically reflect on teaching and learning strategies tailor-made to different cultural and contextual settings. Collaborating on pedagogical reforms can provide solid guidance and insight on implementing student-centred learning for Chinese students in large class learning environments while respecting the cultural dimension of "face".

Nursing students' experience of bullying and/or harassment during clinical placement

PROBLEM OR BACKGROUND

Bullying is a recognised problem in nursing. Nursing students are particularly vulnerable. Bullying and harassment of nursing students can be detrimental to both students and recipients of care.

AIM

This study aims to identify the incidence and nature of bullying and/or harassment experienced by nursing students in Sri Lanka.

METHODS

A cross-sectional survey consisting of eight demographic questions and 15 items specific to the experience of bullying and harassment was administered to nursing students online.

FINDINGS

A total of 656 students from 26 nursing education institutions in Sri Lanka participated. The majority were female with a mean age of 24.4 years. More than a quarter of respondents reported that they had experienced bullying and/or harassment while on clinical placement, with a further 16.7 % being unsure. Most bullying or harassment (55 %) occurred in hospitals with 29 % experienced in community settings. Registered nurses, including nurse managers and clinical facilitators were the most common perpetrators. Verbal abuse was the most frequent type of behaviour reported.

DISCUSSION

These findings support existing literature that indicates that bullying of nursing students is an international phenomenon. The context of this study provides clues as to how culture may influence the problem. There is a need to better understand bullying and harassment in the environments in which it occurs, in order to identify strategies that can bridge cultures and settings.

CONCLUSION

The incidence of bullying and harassment of nursing students in Sri Lanka is concerning. Further research is needed to identify and evaluate targeted strategies to help prevent negative outcomes in all nursing contexts.

The interprofessional practice experiences of final-semester prelicensure BSN students completing clinical immersion: A descriptive qualitative study

BACKGROUND

The goal of interprofessional practice experiences in health professions programs is to develop interprofessional collaborative practice skills.

PURPOSE

The purpose of the study was to explore the meaning final-semester Bachelor of Science in Nursing students attributed to interprofessional practice experiences during clinical immersion.

METHODS

The theoretical framework for this descriptive qualitative study was experiential learning theory. A sample of 12 participants was drawn from final-semester prelicensure Bachelor of Science in Nursing students at a college of nursing at a public research university. Data were collected through one-on-one semi-structured interviews and analyzed through inductive thematic analysis.

RESULTS

The analysis yielded four themes: professional and interprofessional identity, working with team members, communication practices, and trusting relationships. Patterns across themes were clinical environment culture, nursing school preparation, nurse preceptor role, fear/concern/worry, and night shift.

CONCLUSION

Consistency in preceptors, welcoming clinical environments, and opportunities to practice communicating with team members contributed to interprofessional collaborative practice skill development and improved perceptions of readiness for practice. Academic and clinical educators may use findings to (a) identify immersion placements for interprofessional practice experiences, (b) design curricula reflective of interprofessional practice, (c) advance teaching strategies to promote interprofessional practice, and (d) create learning environments that aid in professional and interprofessional identity formation.

Aesthetic Expression as a Means to Nurture "Self" in a Basic Nursing Care Practicum

ABSTRACT

Nursing students develop their professional "self" through clinical placement experiences. Aesthetic expression can be used as a means to reflect students' personal knowing and to convey self as nurtured during their clinical journey. In a postconference session of the Basic Nursing Care Practicum course, six students were asked to draw pictures reflecting their clinical experience and then share their stories. It appeared that nursing students learned the meaning of nursing and caring, and through these meanings, their actual self as nurses was also developed.

Structural equation modeling of factors associated with nursing students' professionalism during the COVID-19 pandemic

This study aimed to determine the factors associated with nursing professionalism among Korean nursing students. This cross-sectional study was carried out using a convenient sample comprising 247 students enrolled in a four-year Bachelor of Science Nursing program from September 6-27, 2021. A self-reported structured questionnaire was employed to explore the relationships among ego-resilience, self-leadership, clinical learning environment, academic satisfaction, clinical competency, and nursing professionalism by utilizing structural equation modeling. The modified model exhibited good fit indices. Learning-related factors, including clinical learning environments, academic satisfaction, and clinical competency, directly affected nursing professionalism. Self-leadership and the clinical learning environment were indirectly associated with nursing professionalism via both academic satisfaction and clinical competency. Regarding ego-resilience, it only indirectly affected nursing professionalism via academic satisfaction. Creating a student-centered learning environment may be vital to improve students' major and clinical performance, thereby boosting nursing professionalism. Furthermore, nurse educators should consider individual psychological aspects of students when designing the nursing curriculum to foster nursing professionalism. Longitudinal studies are needed to determine if our model is available to explain the development of professionalism among nursing students.

Development and Validation of a Clinical Practicum Transition Shock Scale (CPT-Shock) for Korean Nursing Students

Clinical practice is an important educational tool for nursing students, and their emotions during clinical practice should be accurately understood. This study aimed to develop and verify the validity and reliability of a clinical practicum transition shock scale (CPT-shock) to measure Korean nursing students' emotional responses when transitioning from a theoretical learning process to clinical practice. This research design was a methodological study and the content, construct, criterion validity, and reliability of the items were verified. Content validity was evaluated by seven experts. The preliminary survey was conducted on 24 nursing students, and the factor analysis was conducted on 331 nursing students in various regions of Korea. Confirmatory factor analysis confirmed the model fit (χ2/df = 1.741, GFI = 0.930, AGFI = 0.902, NFI = 0.869, TLI = 0.923, CFI = 0.938, RMR = 0.035, RMSEA = 0.047) and established discrimination and convergence validity. Positive and negative correlations were found with existing transition shock (r = 0.779) and clinical practice adaptation (r = -0.505), respectively (p < 0.001), thus establishing criterion validity. The reliability was good, with a Cronbach's α of 0.85. The clinical practicum transition shock scale reflects nursing students' practice environment and is expected to accurately measure nursing students' unique emotional shock.

Virtual reality simulation-enhanced blood transfusion education for undergraduate nursing students: A randomised controlled trial

BACKGROUND

Nurse-administered blood transfusion (BT) is a common form of medical treatment, but nursing students are often excluded from participating in and observing BTs during clinical placements. To address clinical placement limitations, nursing educators have increasingly adopted technology-guided simulation pedagogies, including virtual reality (VR) simulation, for nursing students' clinical skills education.

OBJECTIVES

To develop VR simulation for BT practice and investigate its effectiveness with nursing students.

DESIGN

A single-blinded, two-arm randomised controlled trial.

SETTINGS

One university in Hong Kong.

PARTICIPANTS

A total of 151 nursing students enrolled in a nursing undergraduate course at a university in Hong Kong were recruited via convenience sampling in March 2022.

METHODS

Evidence-based VR simulation videos consisting of 1) animated blood formation physiology and side effects of BT and 2) 360° BT nursing practice were developed. The nursing students were randomly allocated into intervention and control groups. The intervention group (n = 75) received the usual BT education (i.e. Zoom lecture) with the developed VR video education, whereas the control group (n = 76) received the usual BT education (Zoom). The BT knowledge (RBTKQ-O), student satisfaction and self-confidence (SSSC) and self-efficacy (GSES) of BT practice were measured before and after BT education. Intention-to-treat analyses were performed.

RESULTS

The primary and secondary outcomes (RBTKQ-O, SSCS and GSES, respectively) improved over time in both groups. Analysis of covariance revealed that students who received VR simulation reported higher post-intervention measurement scores in BT knowledge and SSCS than those who did not receive VR simulation.

CONCLUSIONS

VR simulation-enhanced BT education effectively enhances the knowledge and SSCS of BT practice amongst nursing students. Nurse educators may adopt VR simulation to enhance the effectiveness of existing BT education for nursing students.

Ad hoc digital communication and assessment during clinical placements in nursing education; a qualitative research study of students', clinical instructors', and teachers' experiences

BACKGROUND

There was a concern about the shortage of nurses that resulted from the Covid-19 pandemic. Therefore, universities and university colleges were instructed to continue educating nursing professionals but were challenged by the social distancing and the limitations of clinical placements and clinical-field instructors. Clinical placement is essential in the students' development of practical skills and knowledge. Thus, transitioning to a digital follow-up platform of communication with the students between the universities/college and the clinical practice sites became necessary.

PURPOSE

To obtain knowledge about the experiences from the university/college teachers, students, and clinical-field instructors regarding the transition to a digital learning environment that resulted from the COVID-19 pandemic.

METHODS

Qualitative individual digital interviews were conducted for data collection at three different nursing education programs from three Norwegian university/university college sites. Five students, four clinical-field instructors, and nine university/college teachers participated (n = 18).

RESULTS

The inductive analyses identified two main themes: (1) Efficiency compromising pedagogical quality, and (2) Digital alienation.

CONCLUSIONS

Students and university/college teachers were worried about fluctuating quality with digital pedagogical. There were concerns that the students educated during this period will have reduced clinical competencies.

Factors Influencing Nursing Student Learning During Clinical Placements: A Modified Delphi Study

BACKGROUND

Factors identified as important to nursing student clinical learning include the environment, the clinical facilitator, and student human factors.

METHOD

A modified Delphi study generated clinical nurse educators' expert consensus of the importance of factors that influence student learning during clinical placements. Short-answer questions exploring facilitation of learning were also provided.

RESULTS

Thirty-four nurse educators participated in the first round, and 17 nurse educators participated in the second round. Final consensus of at least 80% agreement was reached for all factors. Enablers of student learning included a positive workplace culture, student attitude, and clear communication between facilitator and student. Barriers to student learning included lack of time for teaching, short placement duration, and poor student and facilitator attitude.

CONCLUSION

Further investigation is needed on how these factors are addressed during placements including a review of the quality of resources provided to students and clinical facilitators for student learning. [J Nurs Educ. 2023;62(6):333-341.].

Psychometric evaluation of the Arabic version of the Perceived Stress Scale in clinical practicum: Validity and reliability in the Moroccan nursing students

BACKGROUND

During clinical practicum, nursing students are subjected to stressors that can affect their well-being, academic performance, and technical skills. The purpose of this study was to evaluate the psychometric properties of the Arabic version of the Perceived Stress Scale of Clinical Practicum (PSS-CP) in a sample of Moroccan nursing students.

MATERIALS AND METHODS

In this study, a translation and back-translation method and comparisons were made with the original version. The study population consisted of 215 nursing students. The construct validity of PSS-CP was measured using exploratory (EFA) and confirmatory factor analysis (CFA). Convergent validity was demonstrated by correlation with the Arabic version of the Depression, Anxiety, and Stress Scale (DASS-21). For reliability, Cronbach's alpha and test-re-test reliability (with a 10-day interval) were used. Data were analyzed using IBM SPSS Statistics V. 23.0 (SPSS) and AMOS V.21.0 (SPSS) software.

RESULTS

The results showed that the PSS-CP is a reliable and valid scale with good internal consistency and test-re-test reliability. In terms of convergent validity, the PSS-CP showed a positive and significant correlation with the DASS-21 scale items. The results of this study led to a two-factor model consisting of 29 items.

CONCLUSION

The PSS-CP is a valid and reliable instrument for assessing clinical stressors among nursing students in Morocco.

Stress levels of nursing students: A systematic review and meta-analysis

CONTEXT

Nursing students experience psychosocial stress in their workplace. Available statistics are at variance, and hence, the need to know the overall prevalence of psychosocial stress among nursing students.

AIMS

This study aimed to determine the prevalence of psychosocial stress among nursing students through meta-analysis.

MATERIALS AND METHODS

PubMed, Cochrane, Web of Science, CNKI, and China Biomedical Literature Service System were searched for articles. Search terms include "psychosocial stress," "nursing students." Articles were included if they used validated psychosocial stress assessment instruments. Of the 15 articles with data on stress prevalence, 8 met all inclusion criteria. Each article was independently reviewed by the authors and relevant data were abstracted. Statistical analysis was done using Revman 4.1.

RESULTS

Overall, the average score for stress among nursing students was 3.70 (95% confidence interval [CI]: [3.33, 4.06]) based on the analyzed 15 articles with a sample size of 9202.

CONCLUSION

This study showed that the stress level of intern nursing students was mainly moderate.

Senior nursing students' reflections on deviations from guideline adherence regarding venous blood specimen collection practice: A qualitative study

BACKGROUND

Venous blood specimen collection is a common procedure within healthcare and both diagnoses as well as treatment evaluation, are often based on results from these analyses. However, studies among both students and staff have demonstrated suboptimal adherence to venous blood specimen collection practice guidelines which in turn might jeopardize patient safety.

OBJECTIVES

This study aimed to describe final semester nursing students' experiences of deviations from venous blood specimen collection practice guidelines during clinical training.

METHODS

This study adopted a qualitative design. Twentysix final (6th) semester nursing students were recruited through purposive sampling at a Swedish university. Data were collected through semi-structured, face-to-face, focus group interviews in September 2015. The transcribed interviews were analyzed using qualitative content analysis.

RESULTS

The students' experiences generated two categories; 1) Striving to blend in (subcategories Feeling uncomfortable and Adapting to the prevailing practice culture) and 2) Diminished confidence (subcategories Being confused due to inconsistency and Being uncertain about guideline usefulness) forming the overall theme Being a copycat.

CONCLUSION

The research concludes that nursing students adapt to the prevailing practice culture encountered during clinical training, often at the expense of guidelines adherence. Since the students are being assessed during clinical training, the eagerness to belong to the team and be well-liked might be stronger than the ambition to follow guidelines. As a consequence, nursing students in clinical training might become copycats by aligning themselves with the prevailing practice culture which in turn might jeopardize adherence with VBSC guideline practice and thereby patient safety. With the ambition to support nursing students' learning in clinical training, facilitators of learning to comprise both students and supervisors need to be further addressed.

TWEETABLE ABSTRACT

Nursing students adapt to the prevailing venous blood sample collection practice culture and become copycats.

COVID-19 Pandemic Impact on Nursing Student Education: Telenursing with Virtual Clinical Experiences

Introduction

The COVID-19 pandemic affected nursing students dramatically when the clinical sites and the onsite classrooms closed to physical participation. This necessitated a move to virtual classrooms and virtual clinical experiences. Some nursing schools adopted telenursing to comply with their Board of Registered Nursing direct patient care requirements. Students value the hands-on nursing in a direct care facility and clinical instructors must replicate this in a virtual setting. This article discusses telenursing and Teach-Back processes with student active engagement that facilitates learning and meets the direct care requirement. The purpose is to share best practice ideas for clinical instructors to educate when clinical settings are unavailable.

Methods

This innovation includes examples from five clinical instructors when in-person clinicals were not available due to the COVID-19 pandemic. They used virtual teaching and telenursing for nursing students which complied with clinical requirements of preconference, clinical experience, and post-conference. Telenursing combines case studies or shared documents, student collaboration, and includes a patient or patient actor via telehealth. Clinical instructors present a patient history or case study and allow students time for preparation. Socratic questioning helps students focus on determining the correct questions to ask. Telenursing call to the patient and teach-back questioning validated patient learning. Following the call, the instructor leads a post-conference debrief and students independently document the call.

Conclusion

Five clinical instructors follow the process of pre-brief, case presentation, and debrief while students develop critical thinking, strong communication skills, documentation requirements, and utilize the nursing process of assessment, diagnosis, outcome, plan, interventions, and evaluation. Students will have future opportunities to develop hands-on skills as they return to the clinical setting.

The effectiveness of the iLearning application on chest tube care education in nursing students

BACKGROUND

Tube dislodgment has been ranked as the top three medical accidents for five years consecutively in Taiwan. Chest tube care accidents affect patient's health and life significantly. Typically, education on chest tube care focuses on the knowledge transmission with limited guiding nursing students in learning clinical reasoning. The Generation Z students prefer mobile devices. It is crucial to incorporate mobile applications to learning.

PURPOSE

The purpose of this study was to evaluate effectiveness of the teaching intervention program ("iLearning app for chest tube care") in improving nursing students' clinical reasoning ability and self-directed learning.

METHOD

A quasi-experimental study with a cluster sample was used. A total of 107 nursing students were recruited with the intervention group (n = 53) using the "iLearning app" to learn chest tube care, and the comparison group (n = 54) using the "traditional teaching". Data were collected before the intervention, one week and one month after the intervention.

RESULT

The result showed that there was no difference in clinical reasoning and self-directed learning between groups before the intervention. However, the intervention group showed significantly higher clinical reasoning and self-directed learning scores than the comparison group (p < .05) one week and one month after the intervention. It indicated that the students' clinical reasoning abilities and self-directed learning improved with implementation of the intervention.

CONCLUSION

The results indicated that the "iLearning app" intervention improved the clinical reasoning and self-directed learning in nursing students. This intervention used situated learning with concept mapping to guide student learning and demonstrated effectiveness in improving their clinical reasoning ability. Immediate feedback of the course instructor might trigger deeper learning and self-correction of clinical reasoning. The "iLearning app" could be used as a tool to improve students' clinical reasoning and self-directed learning, and thus enhance lifelong learning.

Challenges faced by student nurses and midwives in clinical learning environment - A systematic review and meta-synthesis

OBJECTIVES

This systematic review aimed to offer insight and understanding, through synthesis of findings from studies that report on perspectives of student nurses/midwives, clinical instructors, clinical nurses/midwives on the challenges faced by student nurses/midwives in the clinical learning environment (CLE).

DESIGN

All primary qualitative research studies published in the English language that reported on the views of student nurses/midwives, clinical instructors and clinical nurses/midwives on the challenges faced by student nurses/midwives in the CLE were included.

DATA SOURCES

The electronic databases of Medline EBSCO (1946-), CINAHL (1970), Embase Ovid (1974-), ScielO, WHOLIS (2002-), ASSIA (1985-), Web of Science (1956-), PsycINFO (1800s-) and Maternal and Infant Care (1970-) were searched in November 2019.

REVIEW METHODS

Retrieved papers were reviewed independently by two authors for selection by title, abstract and full text, and two authors agreed for inclusion of the papers. The COREQ criteria checklist was used for assessment of methodological quality of the included studies.

RESULTS

The review included 32 studies published over 22 years between 1997 and 2019 involving 853 nursing/midwifery students, clinical instructors, and clinical nurses/midwives from 14 countries. Three key themes emerged: 'The support structure', 'Personal factors', and 'Planning and organisation - influence of extrinsic factors'.

CONCLUSION

Attitude of clinical staff, instructors, and significant others had a major influence on students' clinical learning. Lack of a sense of belongingness and self-motivation to learn, and perceived fear of doing errors were some of the demotivating factors. Lack of resources to facilitate need-based training, staff shortages, workload and inconsistencies between theory and practice were other key challenges in the CLE. Understanding the challenges faced by students in clinical practice can help overcome the barriers leading to development of competent and confident nurses and midwives.

The use of clinical practice to facilitate community engagement in the Faculty of Health Science

AIM

This article seeks to describe how clinical practice can be used to facilitate community engagement in the Faculty of Health Science.

DESIGN

The study followed a qualitative exploratory, descriptive and contextual design.

METHODS

The study was conducted in the Faculty of Health Science at a public university in Namibia, Southern Africa. A total of 19 academic staff were purposively selected to participate in the focus group interviews. Thereafter, Giorgi's method of phenomenological data analysis was used to analyse data. Lincoln and Guba's strategies were used to establish trustworthiness. The ethical considerations followed Dhai and McQuoid-Mason's four principles.

RESULTS

The three themes that emerged as findings were: facilitation of community engagement through home visits as part of clinical practice; facilitation of community engagement through clinical rural placements; and facilitation of community engagement through interprofessional education and practice.

CONCLUSIONS

It is concluded that health science students and academic staff should conduct home visits, students' placement should also include rural based facilities and allow inter-professional education and practice in clinical practice. However, there remains an overall need to explore for community engagement projects that may be conducted in rural settings. Additionally, a generic service-learning course for all undergraduate health science students may help facilitate community engagement through interprofessional education and practice.

Experiences of undergraduate nursing students during clinical practice at health facilities in Western Cape, South Africa

BACKGROUND

This study explored the experiences of undergraduate nursing students during clinical practice at healthcare facilities in the Boland Overberg area in Western Cape, South Africa. Few studies have been done on experiences of nursing students during clinical practice. However, there are still inadequacies, which lead to the deterioration of clinical practice quality.

OBJECTIVES

To explore and describe the experiences of undergraduate student nurses during clinical practice in healthcare facilities in Boland Overberg, in Western Cape, South Africa.

METHOD

A qualitative, exploratory descriptive design was applied. Data collection was done using focus-group interviews to ascertain the undergraduate student nurses' experiences during clinical practice in healthcare facilities in the Boland Overberg area in Western Cape Region. Thirty-eight undergraduate nursing students from Boland Campus were selected, using purposive sampling. The sample size was based on data saturation. Colaizzi's method of coding and thematic content analysis was used to interpret the data. Ethical principles were adhered to.

RESULTS

After data analysis, the following themes emerged: clinical learning environment, challenges and inability to reach objectives.

CONCLUSION

During clinical practice in healthcare facilities, students were confronted with dilemmas which must be addressed with proper planning to decrease the challenges in clinical education of future nurses. The findings can be used in planning of nursing education, could provide help to develop effective clinical teaching strategies in nursing education and to support these undergraduate nursing students.

Context, complexity and cross-pollination: Nursing leaders' views of the role of the voluntary and community sector in nurse education

BACKGROUND

Placements in voluntary and community sector (VCS) organisations have long played an important part in student nurses' education in several countries. New standards for nurse education published by the Nursing and Midwifery Council in the United Kingdom include significant changes to practice supervision arrangements that enable students to spend more time in VCS organisations.

OBJECTIVES

To assess nursing leaders' views on the role of the VCS in nursing education and benefits of VCS placements for students and organisations.

DESIGN

Qualitative interview study.

PARTICIPANTS

Twenty-four nursing leaders from academic (n=15), practice (n=4) and regulatory (n=5) sectors.

METHODS

Semi-structured interviews were conducted face-to-face (n=21), by telephone (n=2) or Skype (n=1). Interviews were transcribed and analysed, using interview questions as structural themes, followed by inductive thematic analysis.

RESULTS

Nursing leaders identified three key roles for the VCS in nursing education: (1) determining knowledge needs; (2) developing curricula; (3) providing placements. Five key benefits of VCS placements for students were shared: (1) understanding the contribution of the VCS to care; (2) seeing the context and complexity of people's lives; (3) challenging attitudes and perceptions; (4) gaining confidence, knowledge and skills; and (5) supporting career decisions. Three benefits for VCS organisations were found: (1) cross-pollinating knowledge, skills and networks; (2) changing organisational cultures; (3) promoting careers in the VCS.

CONCLUSIONS

Changes to practice supervision models enabling closer relationships with the VCS were welcomed. Nursing leaders thought that VCS placements had potential to cross-pollinate ideas and harness the role of student nurses as knowledge brokers in increasingly integrated health and social care systems. Nurse educators should embrace opportunities offered through collaboration with the VCS for student learning and deeper partnerships across health and social care settings to enable students to gain deeper insight into the context and complexity of people's lives.

Interpersonal skills mediate the relationship between communicative and clinical competencies among nursing students: A descriptive study

BACKGROUND

The development of clinical competency reduces nursing students' stress and turnover intention and improves their clinical practice satisfaction and academic performance. Still, many nursing supervisors feel that new graduate nurses have inadequate communicative and clinical competencies, and no prior study has analyzed the mediating effect of interpersonal skills in the relationship between these two variables.

OBJECTIVES

To examine the factors that affect nursing students' clinical competency, including the mediating effect of interpersonal skills, and to identify/determine interventions that promote it and improve students' clinical performance.

DESIGN

This study employed a cross-sectional, descriptive correlational design.

SETTING

Four departments of nursing in Jeollabuk-do, South Korea.

PARTICIPANTS

Participants (N = 222; mean age = 22.7 years; 75.2% women) were students enrolled in the third and fourth year of nursing.

METHODS

From February 5-28, 2018, we collected data through self-reported questionnaires; these asked about participants' demographic characteristics and measured their communicative competency, interpersonal skills, and clinical competency. The relationships among the variables were identified using Pearson's correlation coefficient. We also used the Sobel test and a three-step multiple regression analysis to verify the mediating effects of interpersonal skills.

RESULTS

Students who were female, in their fourth year, satisfied with their major, and satisfied with their clinical practice had higher clinical competency scores than their counterparts. Interpersonal skills completely mediated the effects of communicative competency on clinical competency (explanatory power = 53.8%).

CONCLUSIONS

The results suggest the need for a program that improves nursing students' social relationship skills and diminishes their anxiety. In particular, students in the third and fourth years need a continuous/intensified curriculum that fosters their communicative competencies, such as listening to patients' needs and establishing effective interpersonal relationships with peers/superiors. Longitudinal studies are warranted to identify differences in communicative/clinical competencies among nursing students in different academic years.

Academic Electronic Health Records in Undergraduate Nursing Education: Mixed Methods Pilot Study

BACKGROUND

Teaching students about electronic health records presents challenges for most nursing programs, primarily because of the limited training opportunities within clinical practice settings. A simulated electronic health record is an experiential, learner-centered strategy that enables students to acquire and apply the informatics knowledge needed for working with electronic records in a safe learning environment before the students have encounters with real patients.

OBJECTIVE

The aim of this study is to provide a preliminary evaluation of the Lippincott DocuCare simulated electronic health record and determine the feasibility issues associated with its implementation.

METHODS

We used one-group pretest-posttest, surveys, and focus group interviews with students and instructors to pilot the DocuCare simulated electronic health record within an undergraduate nursing program in Western Canada. Volunteering students worked through 4 case scenarios during a 1-month pilot. Self-reported informatics knowledge and attitudes toward the electronic health record, accuracy of computerized documentation, satisfaction, and students' and educators' experiences were examined. Demographic and general information regarding informatics learning was also collected.

RESULTS

Although 23 students participated in this study, only 13 completed surveys were included in the analysis. Almost two-thirds of the students indicated their overall understanding of nursing informatics as being fair or inadequate. The two-tailed paired samples t test used to evaluate the impact of DocuCare on students' self-reported informatics knowledge and attitudes toward the electronic health record revealed a statistically significant difference in the mean score of knowledge before and after using DocuCare (before: mean 2.95, SD 0.58; after: mean 3.83, SD 0.39; t 12=5.80, two-tailed; P<.001). There was no statistically significant difference in the mean scores of attitudes toward the electronic health record before and after using DocuCare (before: mean 3.75, SD 0.40; after: mean 3.70, SD 0.34; t 12=0.39, two-tailed; P=.70). Students' documentation scores varied from somewhat accurate to completely accurate; however, performance improved for the majority of students as they progressed from case scenarios 1 to 4. Both the faculty and students were highly satisfied with DocuCare and highly recommended its integration. Focus groups with 7 students and 3 educators revealed multiple themes. The participants shared suggestions regarding the DocuCare product customization and strategies for potential integration in undergraduate nursing programs.

CONCLUSIONS

This study demonstrated the feasibility and suitability of the DocuCare program as a tool to enhance students' learning about informatics and computerized documentation in electronic health records. Recommendations will be made to academic leadership in undergraduate programs on the basis of this study. Furthermore, a controlled evaluation study will be conducted in the future.

Development and psychometric testing of nursing students' perceptions of clinical stressors scale: an instrument design study

BACKGROUND

In clinical environments, nursing students experience a range of stressors that can affect their health, learning, and quality of patient care. This study aimed to develop a Nursing Students' Perceptions of Clinical Stressors Scale (NSPCSS) and to evaluate its psychometric properties.

METHODS

This exploratory, sequential mixed-method study was conducted in 2 phases. In the qualitative (item generation) phase, NSPCSS items were generated using the data collected from semi-structured interviews and a literature review. In the quantitative (psychometric evaluation) phase, face, content, construct, convergent, and discriminant validity and reliability of the scale were tested. To evaluate construct validity, exploratory and confirmatory factor analyses were performed on the data collected from 430 nursing students. Reliability was also assessed through internal consistency and composite reliability.

RESULTS

In this study, 6 factors were extracted from 30 itemes through exploratory factor analysis: (1) instructor's limited competence in clinical environments, (2) inappropriate clinical environment, (3) inadequate knowledge and skills, (4) inefficient education in clinical planning, (5) instructor's inappropriate conduct, and (6) concerns about the characteristics of nursing career. These factors accounted for 58.8% of the total variance. The results of the confirmatory factor analysis suggested the goodness-of-fit indices was acceptable. Furthermore, the internal consistency and composite reliability indices of all factors were greater than 0.7.

CONCLUSIONS

The NSPCSS is a valid and reliable instrument for assessing clinical stressors among nursing students.

Israeli nursing students' acceptance of information and communication technologies in clinical placements

BACKGROUND

Nursing students are required to be adequately prepared to use Information and Communication Technologies (ICT) in clinical practice. Yet, studies conducted worldwide indicate personal, organizational, and social barriers reported by students and a discrepancy between clinical resources and students' needs.

PURPOSE

To explore nursing students' usage of ICT during clinical placement and the associations between students' ICT acceptance, human and organizational resources, and ICT usage.

METHOD

Data were collected from 303 second and third year Israeli nursing students, through a self-administered structured questionnaire.

RESULTS

The use of Medical Health Records during clinical placements was rated highest (M = 4.62, SD = 0.74, range 1-5), whereas the use of e-Books was rated lowest (M = 2.26, SD = 1.37, range 1-5). Positive correlations were found between ICT use and human resources, social influence, organizational resources, and performance expectancy. Significant differences were found according to study years and proficiency in computer skills between students. Perceived human resources, cultural group, Hebrew proficiency, and social influence explained 28% of students' variance in ICT usage.

CONCLUSIONS

Nurse administrators and educators should promote the preparation of clinical settings in accordance with students' needs and proficiencies. Moreover, the development of curricula and clinical practicums must also take into account the role of organizational, social, and computer proficiency in students' ICT adoption.

Construction of professional identity in nursing students: qualitative research from the historical-cultural perspective

OBJECTIVE

to analyze the process of professional identity construction in undergraduate nursing students during their education.

METHOD

qualitative research, anchored in the Historical-Cultural framework. Twenty-three undergraduate nursing students took part. Data were collected through individual interviews, with a semi-structured script. Thematic Analysis was used to analyze the data.

RESULTS

the following four themes were obtained, "The subject in movement to become a nurse: from previous experiences to entering the courses"; "The nursing professor in the construction of the undergraduate's professional identity: a two-way mirror"; "Pedagogical relationship: instrument for constructing the student's professional identity" and "Historical-cultural conditions: space for the construction of the student's professional identity".

CONCLUSION

the construction of the students' professional identity is limited to the material conditions of existence, translating appropriation to the intrapsychic scope of elements that occur, first, in the inter-psychological space of interactions. Nursing professors can become a paradoxical mirror, with one face to be imitated and the other, which materializes meanings of a model not to be followed. This construction is also influenced by the conditions of professional practice and university education.

Night shifts as a learning experience among nursing students across Europe: Findings from a cross-sectional survey

BACKGROUND

Organising clinical placements during nights has been reported as an additional opportunity to introduce students to the whole picture of their future responsibilities. However, studies in this field are still lacking.

OBJECTIVES

To describe and compare (a) the night shift experience of nursing students across Europe, (b) the patient-related problems that they face during night shifts, (c) the night care activities nursing students are called to perform, and (d) the perceived effects of night shift work on learning outcomes.

DESIGN

A cross-sectional study, 2016.

SETTINGS

Five European countries: Czech Republic, Italy, Poland, Portugal, and Slovakia.

PARTICIPANTS

Nursing students from nine Bachelor of Nursing Science degree programmes attending night shifts during their study period and who were willing to participate were included. A total of 907 out of 1347 (67.3%) eligible students participated.

METHODS

Questionnaire based on the available literature, translated into five languages.

RESULTS

The duration of the night shift was from an average of 9.8 (CI 95% 9.6-10.0) in Italy to 11.9 (CI 95% 11.7-12.0) in the Czech Republic. Students faced mainly patients' pain without statistical differences across countries (at the overall level, 717 out of 907; 79%; p = .318). However, significant differences in the tasks performed during nights emerged: Polish students reported being more involved in performing basic nursing care (72; 93.5%) as compared to other countries (e.g., Portuguese students 337; 84.9%), (p = .02). Overall, an average of 28.9% of the night shift time was reported to be free of commitments, with higher values among Polish (38%, CI 95% 33.6-42.3) and Slovakian students (33.4%, CI 95% 30.6-36.3) and lower values among Czech Republic students (20.4%, CI 95% 17.6-23.2) (p .001). Boredom and satisfaction were reported as the main feelings during night shifts, with significant differences (p .001) across countries. Students reported significant different effects (p .001) of night shifts on their understanding of a nurse's role (from 5.2 out of 10 in Poland to 6.5 in the Czech Republic), on the understanding of the continuity of nursing care (from 5.2 in Poland to 6.7 in Italy), and on having a relationship with the clinical mentors (from 2.7 and 4.2 in Poland and the Czech Republic, respectively, to 6.9 in Italy).

CONCLUSIONS

Night shifts can be both a valuable and a non-valuable learning experience, suggesting the need to carefully plan and assess their effectiveness at the unit level.

Professional socialisation of nursing students in a collectivist culture: a qualitative study

BACKGROUND

Beyond the formal curriculum of skill attainment, nursing students are able to undergo the professional socialisation process in clinical contexts and establish their identity as healthcare providers. However, the cultural context that affects the socialisation process in clinical placements is less discussed. We aimed to explore nursing students' learning and professional socialisation during clinical placements by considering the socio-cultural contexts in South Korea.

METHODS

A grounded theory approach was used for this research. Four rounds of in-depth and intensive interviews were carried out, with the recruitment of 16 nursing students, four nurses and two university lecturers in South Korea (29 interviews in total). A constructivist grounded theory framework was adopted to analyse the interview data. NVivo 11 was used to manage the interview data for analysis.

RESULTS

The researchers identified the process of learning and professional socialisation under three core themes: 1) Struggling at the bottom of the hierarchy, 2) Acceptance and conformity, and 3) The need for 'nunchi' (in Korean, it means to study the atmosphere and discover the embedded intention of others' behaviour). The results offered insights into the challenges encountered by nursing students on clinical placements and how students attempt to adapt and conform to the difficulties encountered in clinical education to maximise their learning and for their professional socialisation. The significance of the hidden curriculum was discussed.

CONCLUSIONS

While experiential learning is a great opportunity for students to build on their coping skills and professional socialisation, a lack of support can result in failure to manage the hidden curriculum and theoretical and practical skills. Nursing educators therefore need to orientate students to the professional culture prior to beginning clinical placements.

Nursing profession and nurses' contribution to nursing education as seen through students' eyes: A qualitative study

The behavior of clinical instructors, as observed by students, deeply influences their professional development. When instructors behave unprofessionally, they risk undermining the professional growth students gain from their clinical placement experience. Clinical instructors need to be aware of how their behavior can affect the students' learning process and the contributions they make to clinical nursing education. A qualitative study was performed to describe the nursing profession as perceived by students who observed their clinical instructors' behaviors during the clinical experience. In-depth interviews of nursing students were conducted until data saturation was attained. Sixteen interviews were analyzed using an inductive content analysis methodology. The nursing profession was described by the participants through five themes as follows: the helping relationship, technical role, professional growth, working group, and contradictions and conflicts. Several examples of unprofessional behaviors on the part of the clinical instructors were reported by the respondents. The nursing profession, as perceived by nursing students, does not always reflect their expectations and their ideas related to professionalism. Universities and schools of nursing should ascertain that clinical instructors are prepared to educate students. Faculty should clearly state to students what they can expect from the clinical experience, namely, preparing students to face real working environments that do not always reflect educational philosophies.

Nursing students' learning dynamics with clinical information and communication technology: A constructive grounded theory approach

BACKGROUND

The learning of nursing students can be facilitated through direct and/or indirect experiences of using clinical information and communication technology during clinical placements. However, nursing students experience difficulties in using technology for learning. Despite the difficulties, nursing students' learning dynamics with technology in real clinical contexts is poorly understood.

OBJECTIVES

To develop a theoretical model by identifying nursing students' learning dynamics with clinical information and communication technology and the factors influencing the dynamics.

DESIGN

A constructivist grounded theory approach was employed in order to develop the theoretical model.

SETTINGS

This research was conducted by recruiting nursing students from four universities in Seoul, South Korea.

PARTICIPANTS

Sixteen fourth year nursing students were recruited by purposive sampling.

METHODS

This research collected qualitative interview data in up to four rounds of interviews using open-ended and semi-structured interview questions. A total of 23 interviews were conducted. The data were transcribed verbatim. All interview data were analysed using three coding methods; initial, focused, and theoretical coding. NVivo 11 was used for data management.

RESULTS

This research developed a theoretical model of nursing students' learning dynamics with clinical information and communication technology. The model explains three dynamics that influence nursing students' use of clinical information and communication technology (interpersonal, organisational and emotional dynamics) and the students' responses regarding the dynamics for learning in clinical contexts.

CONCLUSIONS

Nursing educators can use the theoretical model to understand how best to support nursing students in navigating their clinical environments to build competency in using clinical information and communication technology.