Reforming the undergraduate nursing clinical curriculum through clinical immersion: A literature review

Competence and Confidence With Quality and Safety Education for Nurses Competencies by Newly Licensed Registered Nurses

Understanding newly licensed registered nurses' perceived confidence in the Quality and Safety Education for Nurses (QSEN) competency domains and corresponding knowledge, skills, and attitudes will help inform clinical leaders to develop successful transition-to-practice programs. Newly licensed registered nurses and prelicensure nursing students had confidence in their understanding of QSEN competencies as they began their transition to practice. Online learning and virtual practicums were effective for attaining QSEN competencies, offering support for using these interventions in academic settings and transition-to-practice programs.

Design and Implementation of a Nursing Capstone Across a Multisite Health System

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic created profound effects in nursing education. Using a robust academic-practice partnership, a college of nursing and a health care organization collaborated to launch Jefferson Capstone Experience (JCE), an education delivery model that included a one-to-one, 108-hour clinical preceptorship between an experienced RN and an undergraduate nursing student.

METHOD

The expedited design, implementation, and evaluation of JCE is described. The mixed-method program evaluation included surveys, interviews, and focus groups with students, faculty, and preceptors.

RESULTS

Students and preceptors reported high levels of satisfaction with JCE. All parties emphasized the importance of clear and timely communication, academic practice collaboration, and organization. A significant number of capstone graduates accepted a position with a capstone clinical partner.

CONCLUSION

Although the logistics of planning and implementation were challenging, an immersive and largely positive experience was created for undergraduate students, which created a robust hiring pipeline of new-to-practice nurses. [J Nurs Educ. 2024;63(5):292-297.].

Association of self-efficacy and faculty support on students' readiness for practice

BACKGROUND

The nursing shortage is apparent again after nearly five decades of having a stable workforce. One novel development is that new Registered Nurses (RNs) are exiting their careers too early. Many of them leave the profession for multiple reasons such as burnout and family obligations, yet one reason has emerged - lack of readiness for practice, that also drives the RNs to leave the profession.

PURPOSE

The purpose of this study was twofold - (1) to investigate the relationship between students' characteristics, their Generalized Self-Efficacy (GSE), Perceived Faculty Support (PFS), the Assessment Technologies, Inc. (ATI) Comprehensive Predictor RN Exam scores and their self-report of readiness for practice and (2) to examine which variables best explains the students' readiness for practice.

METHODS

A cross-sectional descriptive correlational research design with convenience sampling was utilized. Descriptive statistics were obtained to investigate the students' socio-demographic data. The Pearson r and multiple regression were used to analyze the relationships and influence between dependent variables Casey-Fink Readiness for Practice scale (CFRPS) and independent variables, students' characteristics, GSE, PFS, and ATI scores.

RESULTS

One hundred forty-three (143) out of 416 students in five baccalaureate schools from the western region of the United States participated in the survey. Findings showed GSE and PFS had significant positive correlations with students' readiness for practice. Further, factors of CFRPS in learning strategies, problem-solving, resourcefulness, and team player are best explained by GSE and PFS, accounting for 91 % of the variance.

CONCLUSION

Students' GSE and PFS can contribute to their readiness for practice. Nurse educators must employ strategies that will bolster students' preparedness by improving their sense of self-efficacy and showing them the utmost faculty support.

Nursing roles and responsibilities conducted by registered nurse/BSN student dyads across ambulatory clinical sites in medically underserved communities

BACKGROUND

Increasingly, registered nurses (RNs) are incorporated into ambulatory care teams. Yet, limited research exists on the roles of RNs across these settings.

PURPOSE

The purpose of this study was to examine the roles performed by RNs (and their senior BSN students) in primary care and public health settings.

METHODS

Working with nine RN preceptors, 15 students tracked all patient visits during a 150-h immersion experience using the Typhon™ clinical-tracking software.

RESULTS

The BSN student/RN dyads conducted 1218 patient visits completing 8536 RN roles in 15 distinct categories. Most patients were African American and female (n = 736; 60.1 %) with an average age of 38.4 (SD 22.12). Patient demographics varied by site. The most common roles performed by the RN/student dyad were health assessment, behavioral health screening, and telehealth. Roles of the RNs and the student level of independence were significantly different across sites (Fisher's Exact test [p < .001]).

CONCLUSIONS

Our results argue that RNs are providing substantial value to these FQHC and public heath settings. An academic/practice partnership, including a shared curricular review, can provide a strategic advantage for educators to ensure that health systems realize the unique roles for RNs and educators provide 21st century education.

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.

Leadership in Nursing Science: Four Scholarly Journeys Rooted in Historically Black College and University Excellence

The intricacies of the unique educational and leadership development trajectories of Black PhD-prepared nurse scientists are largely invisible in nursing faculty development literature. A broadened understanding of nursing leadership development and science mentorship can facilitate support for the next generation of Black nurse scientists. Historically Black Colleges and Universities (HBCUs) can serve as formative launch pads for nurse scientist development. However, the role of HBCUs and strategies for supporting robust educational and mentor/training opportunities for Black PhD-prepared nurse scientists require thoughtful description and application. Incorporating an intrapersonal, interpersonal, and integrative leadership framework, we describe and synthesize four Black nurse scientists and HBCU graduates' experiences to highlight early science mentorship and leadership resilience through the excellent educational foundations provided at HBCUs.

A Survey of Clinical Immersion Experiences in Biomedical Engineering

Immersion in clinical environments is generally believed to be a valuable experiential learning opportunity for students in biomedical engineering, both at the undergraduate and the graduate level. Immersion is believed to foster an understanding of medical culture, clinical operations, interprofessional collaboration, and oftentimes allows students to either identify unmet clinical needs. The National Institutes of Health supports efforts through grants to incorporate these clinical immersion programs into biomedical engineering curricula, and this has potentially facilitated an expansion of these programs across the United States. Unknown is how common clinical immersion experiences are in biomedical engineering programs, in general how these are organized and executed, and their goals. We conducted a survey of biomedical engineering programs to learn how many programs offer clinical immersion experiences, over what timeframe and in what formats, and what is known about their goals and learning outcomes. We present here the results of that survey which includes 52 clinical immersion courses and programs, 14 of which either are or were previously funded by the NIH. Each of these courses or programs engages, on average, about 27 students per year, but range in size from 2 to 160. The duration of the immersion experience likewise varies greatly from 3 to 400 h. The objectives of these programs are mostly to identify problems, develop engineering solutions to problems, or to learn clinical procedures. Despite the impressive breadth of experiences revealed by this survey, we still know relatively little about their impact on student learning, motivation, identity, or career path. Desired outcomes and assessment strategies must be better aligned with the structure of the clinical immersion experiences themselves if we are to determine if they are effective in meeting those outcomes, including those of professional preparation.

"We are really starving for respect and support," the struggle of Iranian nurses in adhering to professional values: A qualitative study

AIMS

To investigate nurses' experiences of adhering to professional values in clinical settings.

DESIGN

A qualitative study with a conventional content analysis approach.

METHODS

This study was conducted from January 2021 to March 2022. Semi-structured interviews were conducted with 12 nurses working in different wards of five public and private hospitals in West Azerbaijan of Iran. Data were analysed using the conventional content analysis approach proposed by Graneheim and Lundman (Nurse education today, 24, 2004, 105) RESULTS: "Barriers to nurses' professional values" emerged as the main category of Iranian nurses' experiences in adhering to professional values. Three subcategories of barriers were revealed: "nurses' challenges," "professional suppressors" and "poor working conditions."

CONCLUSION

Barriers in clinical settings can overshadow nurses' professional performance and disrupt their adherence to professional values. Nursing managers must pay attention to nurses' challenges, their professional suppressors and poor working condition to help them promote their professional performance in clinical settings. Thus, nursing managers should not neglect the continuous education of nurses to assist them in increasing their clinical skills by holding practical and theoretical workshops. Improving the working conditions and clinical atmosphere by recruiting a capable workforce and applying psychological and financial support for nurses are essential to increase the quality of nursing care.

The Effects of Clinical Immersion on Readiness for Nursing Practice

BACKGROUND

Traditional clinical education does not prepare future nurses well for practice. Clinical immersion models are recommended to enhance critical thinking, clinical judgment, and confidence with nursing roles and skills. This study explored the effects of implementing an innovative clinical immersion model on readiness for nursing practice for accelerated Bachelor of Science in nursing students.

METHOD

The Casey-Fink readiness for practice survey was used to determine graduate students' confidence and comfort with nursing roles and skills based on descriptive statistics for each survey question.

RESULTS

Study results indicated students who experienced the clinical immersion model had high levels of confidence with nursing roles and felt prepared for practice.

CONCLUSION

Nursing programs should consider implementing clinical immersion models in undergraduate nursing education programs. [J Nurs Educ. 2023;62(1):47-50.].

Relationships between Nursing Students' Skill Mastery, Test Anxiety, Self-Efficacy, and Facial Expressions: A Preliminary Observational Study

Test anxiety and self-efficacy significantly influence the mastery of nursing skills. Facial expression recognition tools are central components to recognising these elements. This study investigated the frequent facial expressions conveyed by nursing students and examined the relationships between nursing skill mastery, test anxiety, self-efficacy, and facial expressions in a test-taking situation. Thirty-three second-year nursing students who were attending a university in a Korean metropolitan city participated. Test anxiety, self-efficacy, and facial expressions were collected while the students inserted indwelling catheters. Using Microsoft Azure software, the researchers examined the students' facial expressions. Negative facial expressions, such as anger, disgust, sadness, and surprise, were more common during the test-taking situation than the practice trial. Fear was positively correlated with anxiety. None of the facial expressions had significant relationships with self-efficacy; however, disgust was positively associated with nursing skill mastery. The facial expressions during the practice and test-taking situations were similar; however, fear and disgust may have been indicators of test anxiety and skill mastery. To create a screening tool for detecting and caring for students' emotions, further studies should explore students' facial expressions that were not evaluated in this study.

Investigating Relationships Between Preparedness for Practice, Grade Point Average, and Demographic Correlates Among Prelicensure Nursing Students

ABSTRACT

Understanding the factors contributing to the clinical preparedness of nursing students provides essential information for their successful transition into the workforce. The aims of this study were to examine preparedness for practice with demographic factors, grade point average, and taking care of multiple patient caseloads. This study used a correlational design with 185 prelicensure nursing students in the midwestern United States. The results showed that self-reported clinical preparedness was associated with program type and externship experience. The findings contribute to nursing education by bringing new information that contributes to the understanding of students' preparedness for practice.

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

BACKGROUND

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

OBJECTIVE

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

DESIGN

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

SETTING

A large regional university in Australia.

PARTICIPANTS

Pre-registration nursing students.

METHODS

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

RESULTS

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

CONCLUSIONS

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

PRACTICE IMPLICATIONS

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

Readiness to Practice in Generation Z Nursing Students

BACKGROUND

Generation Z nursing students born after 1995 have been described as true digital natives with a short attention span and tendencies toward boredom. The purpose of this pilot study is to compare readiness for practice and anxiety and self-confidence during decision making between Generation Z students who completed a 4-week immersive clinical and those in a 14-week immersive clinical.

METHOD

A convenience sample (n = 46) of Generation Z graduating baccalaureate nursing students was surveyed.

RESULTS

Independent samples t tests were conducted, with no statistical differences between groups on any measures.

CONCLUSION

Findings suggest that extended periods of time in an immersive clinical do not influence readiness to practice or anxiety and self-confidence during decision making in the next generation of students. [J Nurs Educ. 2019;58(10):604-606.].

Students' experiences of clinical immersion in operating room and emergency department

Specialty areas, such as the operating room and emergency department, are being hit especially hard by the nursing shortage in the United States. Recruitment and retention is a challenge in these specialty units and may, in part, be due to limited or no exposure in nursing school. Kolb's theory of experiential learning was used to guide this project. The purpose was to investigate students' experiences and intent to pursue employment after a clinical immersion course in either the operating room or emergency department. Six Bachelor of Science in Nursing students participated in a five-week course that included 10 h of web-based education and 80 h of clinical practicum. The objectives of the course were to identify the role and responsibilities of the nurse in the specialty area, explore the standards and recommended practices established by the specialty professional organization, and collaborate with the healthcare team in the specialty area to provide safe, quality care. A thematic analysis of focus group transcripts and students' weekly reflections was conducted. The results of this project suggest immersing students in a specialty area may be a first step in alleviating the shortage in these areas.

More than a cultural experience: Assessing the impact of a medical-surgical international clinical on nursing students' academic performance

A review of the extant literature suggests that there remains a dearth of evidence regarding the evaluation of well-defined outcomes related to international nursing clinical experiences. The purpose of this study was to explore the relationship between students' clinical experience (traditional versus international) and a number of academic outcomes including final medical-surgical course grades, performance on relevant Assessment Technologies Institute (ATI) proctored exams, and National Council Licensure Examination (NCLEX) pass rates. A non-experimental design was implemented using retrospective data obtained from a small university in the Midwest. Students complete a medical-surgical clinical in India during the interim of their third semester in the nursing program. Results of the t-tests show a statistically significant difference in final grades for Adult Health II theory when comparing students who completed a traditional clinical (M = 83.1, SD = 3.8) with those who completed an international clinical (M = 81.6, SD = 5.2); t(100) = 2.0, p = .043. The difference in mean scores for traditional clinical students (M = 70.3, SD = 6.6) versus international clinical students (M = 66.2, SD = 7.2) for the Adult Medical-Surgical proctored exam reached statistical significance, t(119) = 4.5, p ≤ .001. In contrast, there was no significant difference in means scores between the two groups with regard to scores on the Comprehensive Predictor proctored exam (traditional clinical, M = 76.1, SD = 5.9; international clinical, M = 75.2, SD = 6.4); t(121) = 1.0, p = .316. Finally, a chi square test of independence found that the relationship between clinical status and performance on NCLEX was not statistically significant, χ² (1, N = 197) = 0.132, p = .716. Further research is needed to examine the impact of international clinicals on a broader range of outcomes including academic, cultural competency, and clinical performance measures.

Cross-cultural adaptation and psychometric testing of the Verbal and Social Interaction Questionnaire: A cross-sectional study among nursing students in China

AIMS AND OBJECTIVES

To develop and validate the Chinese version of Verbal and Social Interaction Questionnaire for Nursing Students.

BACKGROUND

The development of caring interaction skills is particularly important for achieving better nursing student-patient interactions. Nursing students in China, as in most countries, have often failed to establish a caring interaction with their patients. There is a lack of instruments to explore the difficulties and problems in nursing student-patient interactions in China.

DESIGN

A descriptive, cross-sectional survey was carried out.

METHODS

Data for cross-cultural adaptation and psychometric testing purposes were collected between May 10, 2017 and November 11, 2017. Exploratory and confirmatory factor analyses were performed; pilot testing, content validity and reliability were assessed for the translated questionnaire. EQUATOR guidelines for observational studies (strengthening the reporting of observational studies in epidemiology) were applied.

RESULTS

716 nursing students from four universities in China completed the questionnaire. A pilot testing (n = 32) was conducted at a university hospital. The internal consistency reliability and the intra-class correlation coefficients were satisfactory. The overall content validity index was 0.95. Exploratory factor analysis resulted in a four-factor solution, explaining 61.26% of the variance, and the items had factor loadings ranging from 0.46-0.82. The final model's fit indexes were relatively acceptable. Overall, this instrument demonstrated sound psychometric properties.

CONCLUSION

The Chinese version of Verbal and Social Interaction Questionnaire for Nursing Students has a high level of reliability and acceptable content validity. However, some values in the construct validity assessment were lower than was hypothesised, suggesting a need for further model modification.

RELEVANCE TO CLINICAL PRACTICE

This easy-to-use instrument may help nursing educators, clinicians and managers in the assessment and development of students' interactional skills during their training or student-nurse transition period. Using the questionnaire could both provide the students with a greater understanding of caring interactions and help the nursing educators gain a better comprehension of the students' verbal, social and interactional skills.