Stressors and coping of nursing students in clinical placement: A qualitative study contextualizing their resilience and burnout

New graduate nurses' perspectives on well-being and transitioning into the workforce

BACKGROUND

The COVID-19 pandemic profoundly impacted nurses' well-being and the transition of new nurses into the workplace. The National Academy of Medicine and American Nurses Foundation has announced the need to prioritize well-being research.

PURPOSE

To explore new nurses' perspectives related to factors that influenced their well-being and transition to practice.

METHODS

New graduate nurses (1-2years post graduation) in Hawaii were invited to participate in a qualitative study, September 2023.

DISCUSSION

Participants (N = 25) were predominantly female (84%), Asian (80%), and had 1year of experience (76%). Participants described the effect of the pandemic on their well-being, individual factors they needed to develop, external factors that were barriers or facilitators, and considerations for future interventions to support well-being and transition to practice.

CONCLUSION

The findings highlighted components of interventions needed in the academic and professional setting to support new nurses' successful and sustained transition to the workplace.

Promotion of self-regulated learning through internalization of critical thinking, assessment and reflection to empower learning (iCARE): A quasi-experimental study

BACKGROUND

Self-Regulated Learning (SRL) is key in developing healthcare professionals and lifelong learner. iCARE (internalization of Critical thinking, Assessment, Reflection to Empower learning) model was designed to enhance nursing students' SRL.

AIM

This study investigated the effects of iCARE on nursing students' reflective practice, SRL, self-efficacy and skill performance as compared to conventional group reflection.

METHOD

A quasi-experimental exploratory study was employed on 49 final-year nursing students in a tertiary acute hospital. The iCARE group (n = 24) received guided daily reflective journal with weekly feedback while the group reflection group (n = 25) received group reflection. Both were facilitated by clinical instructors. Participants' SRL score, self-efficacy level and skill performance were measured pre- and post- training. End of posting reflective journal between group was compared. Their experience and perception on both facilitation methods were obtained using questionnaires. Quantitative data were summarised and analysed using Chi-Square test and t-test. Theme coding and content analysis were used to analyse the qualitative responses.

RESULTS

Compared to group reflection group, the iCARE group reported a statistically significant improvement in SRL score, reflective practice, skill performance and self-efficacy in skill performance after a four-week clinical posting. Participants from both groups perceived that reflection helped them learn from peers and experience, enhanced their performance and motivated them to learn. Three unique themes emerged only from the iCARE group: iCARE helped to developed SRL; application of assessment, planning, implementation and evaluation (APIE) improved clinical reasoning; iCARE improved the use of feedback.

CONCLUSION

The findings demonstrated the effect of the iCARE model in enhancing the development of nursing students' reflective practice, SRL and clinical learning outcomes. The design of iCARE model that embeds SRL instructions, APIE framework and SRL focused feedback can promote cognitive and metacognitive development as well as skill performance.

Development and psychometric testing of the clinical adjustment scale for student nurses (CAS-SN): A scale for assessing student nurses' adaptation in clinical settings

BACKGROUND

Nurse education is critical for preparing student nurses for clinical practice, but the transition to clinical settings poses numerous challenges. A standardized scale to assess student nurses' adjustment in the clinical area is lacking in the Philippines.

OBJECTIVE

This paper described the development and evaluation of the Clinical Adjustment Scale for Student Nurses (CAS-SN).

DESIGN

An exploratory sequential research design.

SETTINGS

Nursing schools in three government owned universities in the Philippines.

METHODS

Expert panels and field pretesting established content and face validity. Inter-item and inter-total correlations and Cronbach's α were used to assess the reliability of the scale. Construct validity was evaluated using exploratory factor analysis (EFA). Criterion validity was evaluated with established measures.

RESULTS

The CAS-SN comprises 15 items across three subscales: (1) Professional Growth and Interpersonal Engagement, (2) Clinical Competence and Confidence, and (3) Coping and Support Strategies Reliability was excellent and the validity was satisfactory, with significant correlations with academic adjustment, psychological distress, and dropout intention.

CONCLUSION

The CAS-SN was found to be a valid and a reliable for assessing student nurses' clinical adjustment.

IMPLICATIONS FOR NURSE EDUCATION

The CAS-SN provides a structured framework to assess and monitor student nurses' clinical adaptation, enhancing our understanding of their competence, resilience, and professional identity development. Its integration into nurse education programs can significantly improve the assessment of clinical learning experiences and contribute to better student learning outcomes.

Nursing Students' Resilience and Intent to Work at the Bedside

AIM

The primary purpose of this study was to explore relationships between self-efficacy, peer support, coping style, intent to work at the bedside, and resilience in nursing students.

BACKGROUND

Resilience correlates with one-year retention at the bedside. Retention of bedside nurses improves patient outcomes.

METHOD

A quantitative, correlational design determined relationships between variables. Surveys were completed by 205 participants. Surveys included a program type list, intent to work at the bedside items, the Brief Cope Scale, the General Self-Efficacy Scale, the Peer Group Caring Interaction Scale.

RESULTS

Significant relationships were found between resilience and self-efficacy, resilience and coping style, and peer support and approach coping style. Half of the respondents intended to work at the bedside for two years after graduation. Self-efficacy and avoidance coping were resilience predictors.

CONCLUSION

To support resilience, educators should facilitate students' development of self-efficacy and approach coping style.

Mediating role of psychological resilience in the relationship between self-efficacy and professional identity among nurses

To explore the mediating role of resilience in the relationship between general self-efficacy and professional identity of nurses during the COVID-19 pandemic. A cross-sectional design was employed. A total of 982 nurses from four Grade III, class A hospitals in Shandong Province were investigated using general information questionnaire, nurses' professional identity rating scale, general self-efficacy scale (GSES), and Connor-Davidson flexibility scale (CD-RISC). SPSS22.0 and Amos21.0 were used for data analysis and structural equation modeling.     p  % counseling The nurses had a score of （27.038±5.933） for general self-efficacy score, 38.290±6.234 for psychological resilience, and （114.99±16.209） for professional identity. A positive correlation between general self-efficacy, professional identity, and psychological resilience (<0.01) was found. The SEM analysis shows that psychological resilience plays a mediating role between general self-efficacy and professional identity. The ratio of the effect is 75.155. During the COVID-19 pandemic, the levels of general self-efficacy and professional identity of nurses was medium, while psychological resilience was high. Nurses' general self-efficacy can affect their professional identity through psychological resilience. During the pandemic, the psychological status of nurses should not be ignored. Nursing managers should fully utilize of group and cognitive therapy based on mindfulness to improve nurses' psychological resilience and general self-efficacy, and to promote nurses' professional identity, so as to ensure the lower turnover rate.

The wellbeing shelf: A mixed methods study exploring the impact of a resilience web resource for first year nursing and midwifery students

BACKGROUND

Nurturing a resilient nursing and midwifery workforce is vital for the National Health Service's sustainability. Higher Education Institutions (HEIs) must support students, given the challenges and attrition rates. Nursing and midwifery education uniquely balances tuition and placements, posing challenges, especially for first-year students, who face stressors including lack of familiarity, knowledge gaps, and emotional exposure.

OBJECTIVES

This study aimed to introduce and evaluate a co-designed web-based intervention called 'The Wellbeing Shelf' to enhance resilience among first-year nursing and midwifery students.

DESIGN

An exploratory mixed methods approach was employed, combining quantitative pre- and post-intervention questionnaires and qualitative focus groups.

SETTINGS AND PARTICIPANTS

The study involved 353 first-year nursing and midwifery students at Queen's University Belfast.

METHODS

'The Wellbeing Shelf' was developed through co-design workshops. Quantitative measures included the Connor Davidson Resilience Scale (CD-RISC) and the Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS). Qualitative data were collected through focus group interviews.

RESULTS

Quantitative data showed a decrease in both resilience and wellbeing scores over time. The CD-RISC scores decreased significantly from Time 1 to Time 3. Qualitative findings revealed three themes: "Acquiring" knowledge about wellbeing, "Actioning" self-care strategies, and "Advocating" for self-care among peers and family.

CONCLUSIONS

The study introduced 'The Wellbeing Shelf' as a resource to enhance resilience among nursing and midwifery students. Whilst the resource offered a variety of activities and fostered a sense of belonging, challenges in resource accessibility and student confidence were identified. The study also highlighted the importance of students advocating for self-care practices. Despite the resource's introduction, resilience and wellbeing scores decreased over time, suggesting a need for further research and potentially a control group. Understanding the initial lower resilience of nursing and midwifery students is crucial for future interventions in this high-demand program.

Prevalence of Impostor Phenomenon Among Final-Semester Baccalaureate Nursing Students

BACKGROUND

Impostor phenomenon (IP) is characterized as an internal sense of intellectual fraudulence and the inability to internalize success. It was identified by Clance and Imes in 1978 in a study with high-achieving women and has since been found among other professionals. Studies regarding IP are limited in nursing and among nursing students.

PURPOSE

The purpose of the study was to evaluate the prevalence of IP among senior baccalaureate nursing (BSN) students at a public central Texas university immediately prior to graduation.

METHODS

Senior BSN students were given an anonymous survey utilizing the Clance Impostor Phenomenon Scale.

RESULTS

Of the 86 senior BSN students, 82.5% completed the anonymous survey. Among students, 45.1% experienced moderate IP, 46.5% experienced frequent IP, and 8.5% experienced intense IP.

CONCLUSIONS

The incidence of IP was higher than expected. This study has implications for the future of nursing, including academic retention and postgraduation performance.

Stress, mental health, and protective factors in nursing students: An observational study

BACKGROUND

Nursing students suffer high levels of stress, especially in the first year.

OBJECTIVES

to compare academic stress at the beginning and end of nursing studies; to analyse the relationships between academic stress, mental health, and protective factors; and to examine whether resilience mitigates the effect of academic stress on psychological well-being.

DESIGN

A cross-sectional study.

SETTING AND PARTICIPANTS

Sample was 370 first- and fourth-year nursing students from Spain (University of Castilla-La Mancha, University of Cantabria, and University of Sevilla).

VARIABLES AND DATA COLLECTION

We assessed academic and clinical stress, coping skills, anxiety, depression, psychological well-being, and resilience were measured.

DATA ANALYSIS

We performed a descriptive analysis of the study sample, as well as correlation and hierarchical regression models. Additionally, mediation models were estimated.

RESULTS

First-year students presented higher academic stress than fourth-year students. Clinical stress, anxiety, depression, and emotional coping predicted academic stress, while academic stress, depression, and coping skills predicted psychological well-being. Mediation models showed a significant path between academic stress, resilience, depression, and psychological well-being.

CONCLUSION

Academic stress has a detrimental effect on the mental health. Coping strategies and resilience may be protective factors that should be encouraged in interventions designed to improve psychological well-being.

Developing and validating of educational-therapeutic package based on psychological flexibility for nurses in the intensive care unit of COVID-19: Application of grounded theory

BACKGROUND

Caring for COVID-19 patients has caused high stress and burnses. Therefore, the current research aims to develop and validate an educational-therapeutic package based on psychological flexibility for COVID-19 nurses.

MATERIALS AND METHODS

The approach of this research was Exploratory Sequential Mixed Method, which was carried out in 2019 to 2021. In the qualitative phase, to identify the paradigm model of the research, the grounded theory of the Strauss and Corbin model, purposeful sampling, and in-depth semi-structured interviews with 12 nurses were used. Goba and Lincoln's criteria were used to ensure the accuracy and reliability of the data. In the quantitative phase, based on the Paradarim model, a training package according to psychological flexibility was developed with the approval of 10 experts from the fields of medical, psychology and nursing education.

RESULTS

The qualitative analysis of the data obtained from the interviews led to the identification of 29 primary concept codes, 8 subcategories, and 3 categories in the conceptual format of context, process, and consequence. The categories included "psychological insecurity in the workplace," "strategic immunization in facing special conditions," and "safe communication." "Psychologically safe exposure" was identified as the central category. In several stages, based on the findings of the qualitative stage, the educational-therapeutic package was compiled. The validity of the package was confirmed by calculating two relative coefficients of content validity ratio (CVR) and content validity index (CVI) equal to 0.91 and 0.85, respectively.

CONCLUSION

This research led to the development of an educational-therapeutic package of safe psychological exposure for nurses, which can be used by managers and nurse educators through in-service training courses. Therefore, it is suggested to use training and safe coping strategies to improve the quality of life in nurses.

The role of perceived stress and social support in nursing students' satisfaction with their initial clinical placement: A cross-sectional study

AIM

To explore: a) students' perceived stress, social support and satisfaction with their initial clinical placement; and b) identify the relationship between perceived stress, social support and student's satisfaction with their initial clinical placement.

BACKGROUND

Clinical placements are a central element in shaping future nursing professionals. Students' satisfaction with clinical placements influences their learning outcomes and intention to continue their studies. Students experience stress from various sources during their clinical placements and social support has been found to moderate their stress. However, there is a paucity of studies addressing the associations between perceived stress, social support and satisfaction with the initial clinical placement.

DESIGN

Quantitative cross-sectional study.

METHODS

Participants included 165s-year nursing students enrolled in the bachelor's program at a central university in Israel during their initial clinical placement. Data were collected between December 2022 and February 2023 using an online questionnaire that contained four parts: personal details, perceived social support, perceived stress and satisfaction with clinical placement.

RESULTS

Students' perceived stress was found to be negatively correlated to satisfaction with their clinical instructor (r = -0.47, p < 0.001) and with their clinical placement (r = -0.47, p < 0.001). Positive associations were found between satisfaction with the clinical placement and satisfaction with the clinical instructor (r = 0.67, p < 0.001). Significant differences were found in perceived stress and social support according to sociodemographic characteristics. Students perceived stress, social support from family and friends and satisfaction with their clinical instructor explained 54% of their satisfaction with their initial clinical placements.

CONCLUSIONS

Clinical instructors and nurse educators are central to students' initial clinical experience. It is recommended that they assess students' perceived stress in the clinical environment, integrate stress reduction strategies into the curriculum and encourage students to turn to various sources for social support. These can promote students' satisfaction and success in their studies.

Experiences of Nursing Students Regarding Challenges and Support for Resilience during Clinical Education: A Qualitative Study

Nursing students require resilience to navigate the complexities of clinical practice. This characteristic is essential for managing demanding workloads, unpredictable patient situations, and emotional stressors while maintaining performance and well-being. Fostering resilience helps students develop the capacity to adapt to adversity, overcome setbacks, and remain committed to providing high-quality patient care. This qualitative study explores the challenges and supports influencing nursing students' resilience during clinical education. Interviews with 28 Thai nursing students revealed two key themes: the "experience of vulnerability" and the "experience of meaningfulness". The sub-themes of vulnerability included "navigating uncertainty", "transcending professional struggles", and "being exposed to diverse encounters". The sub-themes of meaningfulness focused on restoring strength through social interactions and engaging in positive transformation. This study highlights the need for comprehensive support systems that address personal and professional vulnerabilities. Integrating caring theory principles could further enhance resilience by emphasizing compassionate care and fostering student empathy. This suggests that instructors and stakeholders can significantly impact student well-being by creating supportive environments built on collaboration, empathy, and mentorship, all of which are aligned with caring theory.

Stressors and coping styles of nursing students in the middle period of clinical practicum: a qualitative study

BACKGROUND

Nursing students encounter various stressors during their clinical practicum; however, the stressors are not the same during different periods. At present, studies on the stressors and coping styles of nursing students in the middle period of their clinical practicum are rare.

AIMS

The current study aimed to explore the stressors and coping styles of nursing students in the middle period of their clinical practicum.

METHODS

A qualitative study with a descriptive phenomenological method was conducted to collect data from 10 nursing students undergoing the middle period of their clinical practicum from December 2020 to February 2021. The data were collected by semistructured interviews using interview outlines prepared in advance. The data were analyzed by Colaizzi's analysis method.

RESULTS

The stressors experienced by nursing students in the middle period of their clinical practicum mainly included personal reasons, teaching arrangements, interpersonal relationships, occupational particularity and career planning. Additionally, nursing students coped with the stressors that they face in the clinical practicum by eliminating stressors and regulating emotions.

CONCLUSIONS

Nursing students experienced various stressors and used a variety of coping styles in the middle period of their clinical practicum, which was different from what occurred in the early and late periods. Targeted interventions should be formulated and implemented to relieve nursing students' stress and guide them to adopt effective coping styles.

Veterinary Nursing Students' Experience in the Clinical Learning Environment and Factors Affecting Their Perception

Student veterinary nurses (SVNs) spend a significant proportion of their training time within the clinical learning environment (CLE) of a veterinary practice. These clinical experiences are vital for building practical and professional skills. To evaluate the current satisfaction of SVNs in the CLE, a cross-sectional survey design was used incorporating a previously validated instrument. To provide understanding of factors that may affect the SVN satisfaction, additional validated tools were added across factors, including resilience, well-being, personality, and workplace belonging. A total of 171 SVNs completed the survey. In addition, two open questions were included to provide greater depth of understanding of the SVN experiences. Results showed that 70.76% of respondents were satisfied/very satisfied with the CLE. Significant factors that affected the satisfaction scores included, depression, anxiety, and stress (p ≤ .001), psychological sense of organizational membership (p ≤ .001), agreeableness (p = .022), and emotional stability (p = .012). The qualitative data demonstrated shared SVN factors that are considered to contribute to clinical learning and those that detract from clinical learning. Educational facilities and training veterinary practices can support the SVN within the CLE by creating a greater sense of belonging, considering the SVN individual personality and well-being, and including the SVN in discussions around learning support needs.

The COVID-19 Lived Experience Through the Eyes of Nursing and Social Work Students

Purpose: The purpose of this study was to explore the lived experiences of nursing and social work students who were taking courses during the COVID-19 pandemic. Focus group discussions gave students a chance to express the pandemic's effects on their education and life. Methods: A hermeneutic phenomenological approach using Van Manen's Four Lifeworld Existentials guided this study. Using an open-ended format, interviews were conducted in 6 small groups ranging from 2 to 9 individuals, in person or via Zoom. The study was conducted from May to August 2022 in a university setting with 23 participants. Results: Ten existential themes emerged: Being Behind, Groundhog Day, Trying to Keep Up, Loss of Community, Fear of COVID, Being Alone, What is Self-Care?, Is This Career Right for Me?, What is Healthy?, and Access to Counseling. Conclusions: Participants indicated that the COVID-19 pandemic negatively impacted educational delivery, limiting learning opportunities and increasing feelings of isolation, stress, and anxiety. Implications for Education and the Future Workforce: Projected health-care workforce shortages may be exacerbated by students departing from the health-care professions as a result of increased burnout. Resilience training while in school is necessary to help promote coping, self-care strategies, and retention in the health-care professions.

Latent profiles of academic resilience in undergraduate nursing students and their association with resilience and self-efficacy

AIM

This study aimed to investigate the heterogeneity of academic resilience among nursing students using latent profile analysis and its associated influencing factors.

BACKGROUND

Nursing students experience higher levels of stress compared to their peers in other professions, and the cultivation of academic resilience plays a pivotal role in their ability to effectively cope with this stress. Academic resilience not only facilitates success in the face of academic adversity but also contributes to the promotion of mental well-being among nursing students. However, the current research on the academic resilience of nursing students has predominantly focused on a scale-centered total score approach, disregarding individual variability, and hindering the development to inform personalized interventions for enhancing academic resilience.

DESIGN

A cross-sectional study.

METHODS

A convenience sampling method was used to collect a total of 644 nursing students from two medical schools in Guangzhou City. The participants were recruited through an online survey conducted from January to March 2023. The questionnaires consisted of a general information form, the Chinese version of the Academic Resilience Scale-30 (C-ARS-30), the 10-item Connor Davidson Resilience Scale (CD-RISC-10), and the General Self-Efficacy Scale (GSES). Latent profile analysis was used to identify distinct categories of academic resilience among nursing students, and influencing factors were examined through ordinal logistic regression analysis.

RESULTS

The academic resilience levels of nursing students can be divided into three potential categories: 'low academic resilience' (13.0%), 'moderate academic resilience' (70.0%), and 'high academic resilience' (17.0%). Level of grade, GPA, self-reported physical health level, resilience and self-efficacy were significantly influenced the different categories of academic resilience of nursing students (P<0.05).

CONCLUSIONS

The majority of undergraduate nursing students were placed in the moderate academic resilience group, however, educational institutions should pay special attention to nursing students demonstrating low levels. Regular assessments of academic resilience are recommended, and personalized interventions should be tailored to address specific academic resilience characteristics across different grades of nursing students. Strategies aimed at enhancing academic resilience among nursing students may include improvements in GPA performance, attention to physical health, and the reinforcement of resilience and self-efficacy.

Pre-service nurses' experiences of simulated health education classes: A phenomenological study

With the growing demand for health education, enhancing nurses' ability to deliver such education is vital. This phenomenological qualitative study, employing convenience sampling, investigates pre-service nurses' experiences in simulated health education classes. The study included 32 fourth-year pre-service nurses from the Department of Nursing at a South Korean university. Between April 20 and June 30, 2022, these participants documented their perceptions of the simulated classes in self-reflection journals. The researcher utilized the phenomenological research method as proposed by Colaizzi (1978) to analyze the data. The findings suggest that simulated health education classes offer an opportunity to bolster pre-service nurses' practical knowledge, fostering their growth as nursing educators. The pre-service nurses reported gaining confidence in their roles as educators and enhancing their professionalism through these simulated classes. Therefore, as public health promotion becomes increasingly crucial and the demand for health education rises, simulated health education classes serve as a valuable adjunct to teaching methods in health education.

Mediating effect of psychological capital on the relationship between mental health literacy and coping styles among newly recruited nurses

BACKGROUND

Newly recruited nurses face multiple sources of stress and their coping styles need to be focused on to ensure good mental health. This study aimed to examine the relationship among mental health literacy, psychological capital and coping styles in newly recruited nurses.

METHODS

A cross-sectional study was conducted in August and September 2022. A total of 315 newly recruited nurses were recruited in a tertiary hospital in Henan Province, central China, employing the convenience sampling method. The self-reported questionnaires were sent through a QR code, including the Mental Health Literacy Scale for Healthcare Students, Psychological Capital Questionnaire, and Simplified Coping Style Questionnaire. Pearson correlation analysis was used to evaluate the relationships among the variables. Mediation analysis was performed to identify the mediating effect of psychological capital on the relationship between mental health literacy and coping styles.

RESULTS

Positive coping showed a positive relationship with psychological capital and mental health literacy, while negative coping showed a negative relationship with psychological capital and mental health literacy. For positive coping, psychological capital was a partial mediator with an effect of 0.140, accounting for 62.8%. For negative coping, a full mediating effect was shown by psychological capital between mental health literacy and negative coping, with an indirect effect of -0.048.

CONCLUSION

Psychological capital plays a partial and complete mediating role between mental health literacy and different coping styles among newly recruited nurses. Diversified training and personalized guidance in improving mental health literacy and increasing psychological capital simultaneously can be provided to newly recruited nurses continuously to adjust their coping styles.

Barriers and facilitators to the formation of professional identity among nursing students: A four-year longitudinal qualitative study

BACKGROUND

Nursing professional identity (NPI) is essential for nurses to develop their nursing profession. It reflects the competencies consistent with the professional practices of nurses and contributes to them providing better healthcare and public health. The formation process of NPI started with undergraduate nursing education and continued throughout the nursing career.

OBJECTIVE

To explore nursing students' perceptions of facilitators and barriers to the formation of NPI during their study.

METHODS

A 4-year longitudinal, qualitative research design with yearly semi-structured interviews undertaken from 2019 to 2022. The reflexive thematic analysis methodology was applied for the data analysis.

RESULTS

Ninety-three nursing students were recruited, joining a group or individual interview. The four-year nursing baccalaureate program revealed a dynamic formation process of NPI: "Outsider of nursing", "Entering the nursing courses", "Building nursing competence", and "Thinking and acting like a nurse". A total of 12 themes were identified to present the barriers and facilitators to the NPI formation at different stages. Specifically, the six barriers include conflict between their ideals and reality, sociocultural stereotypes about nursing, the negative impact of COVID-19, the pre-internship concerns, struggling to meet expectations, and potential danger and discrimination in the healthcare settings. The enablers were: self-motivation and inner belief towards the nursing profession, the power of role models, the improvement of nursing capacity, well integration into the healthcare professional teams, understanding of the clinical environment, and recognition and encouragement from others.

CONCLUSIONS

The formation of nursing students' NPI is an ever-changing process, with various intrinsic and extrinsic influences during their four-year study. Nursing educators are suggested to prepare and develop students' professional comportment in their theoretical and clinical practice to develop their professional identity as a nurse.

Over twenty years of pedagogical research from Nurse Education in Practice: A bibliometric analysis from 2001 to 2023

AIM

To present a bibliometric overview of pedagogical research from Nurse Education in Practice from its inception in 2001 up until 2023.

BACKGROUND

Bibliometric methods are useful in analysing and understanding the characteristics of scientific publications in a particular field and the influence of specific journals. However, no bibliometric analysis of a nurse education journal has been undertaken to date which would highlight important research trends in this area of nursing and midwifery.

METHODS

A total of 2231 publications (articles and reviews only) from Nursing Education in Practice were retrieved from the Scopus database between 2001 and 2023. Several software applications including Microsoft Excel and VOSviewer were used to undertake bibliometric analysis on this dataset. Publication trends such as country analysis, author analysis, keywords analyses (cluster, content and trend analysis) were generated to help understand the volume and scope of pedagogical nursing and midwifery research in this journal.

RESULTS

There has been a steady increase in pedagogical research from Nurse Education in Practice since its launch in 2001 up until 2018, with a dip in publications in 2022 most likely due to the impact of restrictions during the coronavirus pandemic. The most prolific institutions publishing in the journal are mainly from the United Kingdom, Australia and the United States, with over eighty countries represented demonstrating its global reach and impact. Nursing students, nursing education, simulation and learning are some of the most frequent author keywords.

CONCLUSION

The diversity of pedagogies in nursing and midwifery education, clinical learning and supervision in practice environments, and competence and confidence when transitioning to practice are the most popular research areas in Nurse Education in Practice. This study informs nurse and midwife educators and scholars about the volume and scope of pedagogical research in nursing and midwifery. It also makes recommendations on how to improve aspects of scholarship in education and areas for future pedagogical research.

Investigation of nursing students' emotional states toward challenging situations in clinical practice and metaphorical perceptions of the concept of a nurse

AIM

This study aims to determine nursing students' emotions toward the challenging situations they encounter in clinical practice and their metaphorical perceptions of the concept of a nurse.

BACKGROUND

Challenging situations in clinical practice negatively affect nursing students' perceptions of the nursing profession and their professional learning and development.

DESIGN

The study is based on quantitative, metaphorical and picture-drawing analysis.

METHODS

The quantitative and qualitative parts of it were conducted with 200 nursing students attending their first and second years in the 2021-2022 academic year. The Draw a Picture of a Cactus Test was carried out with 30 students in clinical practice. The data were collected using the "Sociodemographic Information Form" and the "Semi-structured Interview Form". Content analysis techniques, descriptive statistics, picture analysis and psychological tests were used to evaluate the data. The study was reported based on Standards for Reporting Qualitative Research (SRQR).

RESULTS

Nursing students involved in the study produced 37 metaphors related to the "concept of a nurse" and three most expressed ones were "mother, lifeguard and helper." The metaphors produced by nursing students were categorized under six roles: "caregiver, educator, supporter, researcher, administrator and therapeutic/rehabilitator". The pictures drawn by the students about the challenging situations in clinical practice and the expressions they used were associated with self-centeredness (n=21), being attentive (n=19), aggression toward peers (n=13), low motivation (n=11) and need for protection (n=11). Nursing students experienced feelings of loneliness, passivity and anxiety when navigating difficult conditions in clinical practice.

CONCLUSIONS

Metaphors and picture drawing allow a unique approach to the concept of nursing and nursing students' emotional states toward challenging situations in their clinical practice.

Nurse and midwife navigator resilience, well-being, burnout, and turnover intent: A multi-methods study

PURPOSE

To explore levels of Navigator resilience, well-being, burnout, and turnover intent.

DESIGN

A longitudinal, multi-methods study concurrently collected quantitative and qualitative data over three years.

METHODS

A survey and Action Learning Groups.

FINDINGS

No statistically significant change in resilience, well-being, burnout, or turnover intent. Supports, self-care and leaving the position, were used to maintain well-being.

CONCLUSIONS

While quantitative measures did not change, qualitative data demonstrated how adaptive coping mechanisms maintain well-being. Recommendations for nurses working in Navigator, or similar community/public health roles include work-based programs targeting support, good leadership, governance systems including their impact on turnover intent.

CLINICAL EVIDENCE

Job turnover intent can be used as a mechanism to monitor resilience and well-being.

Predictors of Academic and Clinical Stress Among Nursing Students

Introduction

Nursing students experience significant academic and clinical stress due to challenging coursework, assessments, and educational demands, as well as the pressures associated with gaining practical healthcare experience. These challenges can lead to anxiety, fear of making errors, and concerns about patient well-being, ultimately impacting students' mental health and their preparation for a nursing career.

Objective

assesses the predictors of academic and clinical stress among nursing students.

Method

A cross-sectional study design was used with a convenience sample of 113 nursing students. The study team conducted the study at the Faculty of Applied Medical Science, Nursing Department at Prince Sattam bin Abdulaziz University. The researchers used three instruments for data collection and asked all nurse students to complete the online questionnaires, which utilized perceived clinical settings and academic stress.

Results

The mean age of the studied nursing students was 21.2 years old. The study observed students had moderate perceived stress levels furthermore, the total levels of the academic stress domain's mean and standard deviation in students were 90.5 ± 32. Also, a significant relationship between perceived stress and clinical setting hours per week in nursing students, and hospital clinical setting type in nursing students. There was a correlation between academic stress and the ages of students. Students' academic stress was statistically significantly correlated with their educational level.

Conclusion

Academic and clinical stress significantly impacts nursing students; the most common reasons that increase stress are fear of making mistakes and harming the patient.

Recommendation

Accordingly, the study advocates for developing educational strategies and a structured course curriculum before student nurses are sent to clinical areas to enhance their capabilities and reduce academic and clinical stress.

Dialogues with human books to promote professional commitment and learning among first-year nursing students: A mixed-methods study

BACKGROUND

First-year nursing students in Taiwan typically have a limited understanding of nursing as they initiate their studies. Curriculum demands can be overpowering, and students may become averse to developing a positive commitment toward nursing. One strategy to assist in inculcating professional commitment is the integration of a Living Library with "human books."

OBJECTIVES

This study aimed to investigate the effects of interacting with human books on first-year nursing students in terms of their professional commitment, learning motivation, and learning career adaptability.

DESIGN

A mixed-methods, pretest-posttest study design was used.

METHODS

The convenience sampling method was used to recruit 46 students with the following eligible criteria: enrolled in an introductory nursing course, first-year students in the 2022-2023 academic year, and willingness to participate in the study. Participants interacted twice for 20-30 min using self-regulated learning with human books. Quantitative outcomes were professional commitment, learning motivation, and learning career adaptability using the IBM SPSS Statistics V28.0 for statistical analysis. Qualitative outcomes came from the content analysis of written feedback.

RESULTS

Participants experienced a significant improvement in their professional commitment, learning motivation, and learning career adaptability after engaging with human books. Contents analysis of feedback showed four categories: Professed value for nursing, motivation to pursue a career in nursing, reflection and transformation, and positive career possibilities and expectations.

CONCLUSION

Human books offer a novel strategy for nursing students to learn from real-life experiences to enhance professional commitment and learning for a nursing career.

The process and indicators of resilience among nursing students in clinical practicum in Taiwan: A qualitative study

Background

Resilience is essential for managing stress and maintaining equilibrium. During the clinical practicum, nursing students may experience tremendous physical and mental stress, and these negative experiences are considered a source of resilience for students. However, no universal definition of resilience among nursing students exists in the literature, occasioning the need to define the processes and indicators of resilience.

Purpose

This study aims to explore the resilience process and indicators among nursing students in clinical practicum in Taiwan. Participants: Fifteen fifth-year junior college nursing students in Northeastern Taiwan who had completed the clinical practicum were interviewed, including 12 females and three males. All participants were aged 20.3 ± 0.61 years and all participants had clinical practicum experiences over four months.

Methods

A qualitative descriptive study, using purposive and snowball sampling methods, was conducted to collect the experience of the nursing students in their internship. Data were collected using a semi-structured guide and deep interviews, and analyzed through the content analysis method by Waltz, Strickland, & Lenz (2010).

Results

Based on the participants' practical experiences during their clinical practicum, three main themes and nine indicators were identified. The resilience of nursing students is considered a process. The main themes are (1) uncontrolled clinical practical stress, (2) Maintain learning-life balance, (3) Positive attitude toward nursing.

Conclusions

Resilience is a critical factor to stabilize nursing students and enable them to recover from adversity. Both positive and negative experiences significantly impacted the students' attitudes and confidence levels during the clinical practicum. The findings will provide faculty to adapt their teaching method to various situations of nursing students.

Cerebellar Dysfunction and Relationship With Psychopathology, Cognitive Functioning, Resilience, and Coping in Schizophrenia

ABSTRACT

In this study, we examined the cerebellar dysfunction in schizophrenia by evaluating the clinical, cognitive, resilience, and coping correlates of cerebellar signs (CSs) in 162 subjects (63 patients with schizophrenia and 99 healthy controls). The presence of CS was evaluated based on six clinical tests. Measures to assess the severity of psychopathology, cognitive functioning, resilience, and frequency of coping strategies used were included. Patients had more CS than controls. Patients with more CS were older, had more severe psychopathology, had poorer performance on Brief Assessment of Cognition for Schizophrenia token motor task, and used less self-distraction as a coping strategy than those with fewer CS. Patients without CS used less self-blame coping at higher level of resilience. The association of less self-distraction with more CS may be related to cognitive inflexibility as a result of cerebellar dysfunction. Greater attentiveness to the presence of CS in schizophrenia patients may aid in better management of their psychotic condition.

Impact of resilience-based intervention on emotional regulation, grit and life satisfaction among female Egyptian and Saudi nursing students: A randomized controlled trial

AIM

Evaluate and compare the impact of a resilience-based intervention on emotional regulation, grit and life satisfaction among female Egyptian and Saudi nursing students.

BACKGROUND

Nursing students should experience a comprehensive learning environment since they are mind-body-spirit creatures. Therefore, nursing education should emphasize growing students' physical, social, emotional and spiritual well-being in addition to their knowledge, skills and attitudes.

DESIGN

This study followed a parallel arm randomized controlled trial design. Study participants were randomly assigned to the intervention or control groups in a (1:1) ratio. It was conducted between January 2023 and the end of April 2023.

METHOD

Students were randomly allocated to the eight-week resilience intervention (n= 60) or a control (n= 60) group (half of the students in each group were from each country). The intervention group received a pamphlet and attended eight weekly 15-person sessions on resilience, grit (perseverance), emotional regulation and self-care. The Emotion Regulation Questionnaire, the Short Grit Scale and the Satisfaction with Life Scales were administered pre- and immediately post-intervention.

RESULTS

Between pre- and post-intervention, there were significant improvements in grit (from 41.374.27 to 51.235.22 among Egyptian students with an effect size of 0.663 and from 42.974.30 to 54.103.87 among Saudi students with an effect size of 0.800), as well as mean emotional regulation (from 36.635.11 to 55.707.51 among Egyptian students with an effect size of 0.818 and from 44.606.87 to 61. With a substantial effect size of 0.850 (p0.001), Egyptian nursing students experienced a more significant rise in mean life satisfaction than Saudi nursing students (18.336.54 to 29.305.14).

CONCLUSION

Resilience-based interventions enhanced emotional regulation, grit and life satisfaction in Egyptian and Saudi female nursing students. Grit, resilience and emotional regulation should be incorporated into nurse training to equip female students with the necessary values and protective factors to succeed in their studies. Given the unique challenges and stressors that female nursing students may face, nursing programs and institutions must provide resources and support services to help students manage stress and build resilience.

The relationship between resilience and solution-oriented thinking in nursing students

OBJECTIVE

This study aimed to determine the relationship between resilience and solution-oriented thinking in nursing students.

BACKGROUND

Although resilience seems to be related with solution-oriented thinking in nursing students, there are only a few studies investigating these two variables in the literature.

DESIGN

This is a cross-sectional survey study.

METHODS

This study was conducted with 585 nursing students in Turkey, between February 2022 and May 2022. The data were collected using a personal information form, the resilience scale for nurses (RSN) and solution-focused inventory (SFI). To analyze the data, descriptive statistics, t-test, ANOVA, Pearson's correlation and multivariate linear regression analysis were used.

RESULTS

In this study, the mean scores the nursing students obtained from the RSN and the SFI were 71.96 (SD 8.11) and 51.49 (SD 6.21), respectively. The correlation analysis revealed a significant positive correlation between resilience and solution-oriented thinking. Gender, economic status, grade point average and solution-focused thinking skills were determined to be the significant predictive factors of the resilience levels of the students.

CONCLUSIONS

This study shows that solution-oriented thinking is an important determinant of resilience. Therefore, starting from the first year of nursing education, students' resilience levels and solution-oriented thinking skills should be evaluated, and the curriculum should be arranged to increase students' resilience levels.

Hardiness and Zoom Fatigue on Nursing Students: A Cross-Sectional Study in Indonesia During Online Learning

Introduction

The Covid-19 pandemic caused a change in learning methods to online learning. Zoom fatigue is a problem that many students experience during online learning. Zoom fatigue has an impact on physical and psychological problems so that it disrupts the online learning process. Hardiness is needed by students in order to adapt to online learning.

Aim

The purpose of this study was to determine the relationship between hardiness and zoom fatigue in nursing students at Universitas Padjadjaran.

Methods

This study used a quantitative approach with a cross-sectional study design. The sample technique used total sampling. Respondents were 480 nursing students at Universitas Padjadjaran. The research instrument used the Zoom Exhaustion & Fatigue Scale questionnaire and the Hardiness Instrument for the Online Learning.

Results

This study shows that almost half of the respondents have a medium hardiness level category (45%) and a zoom level of medium fatigue category (46.67%). The results of the analysis show that there is a significant negative relationship between hardiness and zoom fatigue in nursing students at Universitas Padjadjaran. The higher the student's hardiness level, the lower the student's zoom fatigue level. High hardiness can increase focus during the learning process, increase student participation, and reduce stress and fatigue in students during online learning.

Conclusion

Lecturers and students need to collaborate to improve the learning process and repeat mental health problems during online learning. This data forms the basis for university and school nurses in providing interventions for nursing students to reduce the problem of zoom fatigue.

Problematic internet use and psychological distress among student nurses: The mediating role of coping skills

Problematic internet use has become a growing concern among student nurses, posing potential risks to their well-being and academic performance. Yet, the extent to which coping skills can help alleviate the adverse effects of problematic internet use on the psychological well-being of student nurses remains largely understudied. This study examined the mediating role of coping skills in the relationship between problematic internet use and psychological distress among student nurses. This cross-sectional study was conducted to collect data from 279 student nurses enrolled in a public-funded nursing school. Mediation analyses were conducted using the PROCESS Macro with Model 4. Findings showed that student nurses reported moderate levels of problematic internet use with a mean score of 2.233 (SD = 0.765). Several factors strongly predicted problematic internet, including being on the 3rd year of education (β = -0.261, p < 0.001), having an average academic performance (β = 0.184, p = 0.006), and using the internet for <3 h per day (β = -0.304, p < 0.001). Problematic internet use was significantly associated with increased psychological distress (β = 0.1791, p < 0.01). Coping skills were found to mediate the relationship between problematic internet use and psychological distress (β = 0.0160, SE = 0.0095). Overall, this study sheds light on the determinants of problematic internet use among student nurses and its negative impact on psychological well-being. By addressing problematic internet use and promoting healthy coping mechanisms, nursing education can better prepare student nurses to maintain their well-being and academic performance in the digital age.

Associations among stressors, perceived stress, and psychological distress in nursing students: a mixed methods longitudinal study of a Hong Kong sample

Background

Nursing students are at risk for high-stress levels and psychological distress. Limited longitudinal studies have been conducted examining factors associated with stress levels and psychological distress of nursing students in their course of study.

Purpose

The purpose of this study was to examine the levels of stress and corresponding stressors, particularly those predicting psychological distress, among nursing students over their 5 years of study.

Methods

A longitudinal design, using questionnaires and focus group interviews of a single cohort of nursing students in Hong Kong and following them over their 5 years of training. The Stressors in Nursing Students Scale-Chinese version and the Chinese version of General Health Questionnaire-12 were used to assess stress levels and psychological distress, respectively.

Results

Ninety-seven participants completed the questionnaires 5 times. Quantitative findings revealed that the overall stress levels of the nursing students increased over 5 years (from mean = 3.08 to 3.33), with the highest levels in the second wave (mean = 3.33). Nursing students experienced higher stress during years 2 (p = 0.006) and 4 (p = 0.037). Psychological distress was the highest in year 3 (sum score = 18.47) (p = 0.002) but declined from year 4 (p < 0.001). Thematic analysis revealed that academic performance issues, coping challenges, unfavorable learning environments, relationships were identified as the stressors. However, nursing students also used positive coping strategies to pursue success and seek support.

Conclusion

This study suggests that the year of study is a significant predictor of stress levels among nursing students, especially during the first and senior years due to heavy academic workload. Psychological distress was observed among nursing students, and those who worked more part-time jobs tended to report higher levels of distress. The junior year was associated with higher levels of distress related to financial and time-related stress, while academic and personal problems were more prevalent during the senior year.

The relationship between perceived stress and emotional intelligence in Moroccan nursing students

BACKGROUND

Nursing students are subjected to many stressors during their clinical practicums. Emotional intelligence (EI) could act as a real stress regulator. In this perspective, we sought to study the relationship between stress and EI in a sample of Moroccan nursing students.

MATERIALS AND METHODS

This study was conducted using the descriptive correlational method. The statistical population consisted of the nursing students of the Higher Institute of Nursing Professions and Health Techniques of Tetouan in Morocco during the academic year 2021-2022. Among them, 146 participants were selected on the basis of simple random sampling. Participants completed a self-administered questionnaire addressing sociodemographic factors, perceived stress (the Perceived Stress in Clinical Practice Scale), and emotional intelligence (Wong and Law Emotional Intelligence Scale test). Descriptive statistics were used and Pearson's correlation coefficient was applied to assess the correlation between stress and EI, and to compare them according to socio-demographic characteristics. A linear regression analysis was calculated to analyze the effect of independent variables on perceived stress and EI. For the analysis, a level of 0.05 was chosen.

RESULTS

The overall mean age of the students was 20.02 ± 1.12 years. Participants had moderate levels of perceived stress (M = 2.42 ± 0.77) and high levels of EI (M = 3.79 ± 1.09). A significant positive correlation between perceived stress and EI was found (r = 0.741, P < 0,05). The regression model shows that EI, education level, and clinical practice setting can explain changes in perceived stress levels and are effective and significant factors (P < 0,001).

CONCLUSION

EI has been shown to be a protective factor against stress in nursing students. Those with well-developed EI have lower levels of stress. Therefore, it is suggested that a mindfulness-based training program be incorporated into the nursing curriculum to develop emotional skills and combat stress in students.

Stress and Coping Strategies of Online Nursing Practicum Courses for Taiwanese Nursing Students during the COVID-19 Pandemic: A Qualitative Study

BACKGROUND

The coronavirus disease (COVID-19) pandemic has resulted in significant changes in nursing education. Maintaining social distance could slow down the spread of COVID-19, and it was necessary, but it significantly reduced students' hands-on clinical practice experience in healthcare settings. Traditional classroom teaching in schools has transitioned to distance or online learning methods, which significantly reduced students' hands-on clinical practice experience in healthcare settings. Although distance education had been implemented for a long time, there are many problems and challenges to be resolved. The experiences and needs of nursing students in remote clinical training urgently require further understanding.

PURPOSE

To understand the stress and coping strategies of online nursing practicum courses for Taiwanese nursing students during the COVID-19 pandemic.

METHODS

A qualitative research approach with purposive sampling was supplemented by snowball sampling. Semi-structured interviews were conducted, and the data were collected following the eight-step process outlined by Waltz, Strickland, and Lenz (2010). The participants were 12 nursing students on a two-year nursing RN-to-BSN program at a university in Eastern Taiwan, consisting of 11 females and 1 male student.

FINDINGS

The stress and coping behaviors of nursing students consist of four main themes, each with three subthemes, including "urgent changes", "the gaps between online courses and practical operations", "mixed feelings of joy and anxiety" and "unexpected gains".

CONCLUSIONS

The pandemic has impacted nursing students' learning and living. Engaging in online nursing practicum brought about significant stress; nevertheless, students employed various coping strategies to navigate through this challenging period. The findings of this study would also help nursing educators understand the learning gaps in clinical practicum among students.

Cortisol dynamics in undergraduate nursing students during clinical practice: protocol for an exploratory cross-sectional study

INTRODUCTION

This paper presents a protocol for the Investigation of Cortisol Dynamics in Undergraduate Nursing Students, a funded project aiming to understand the fluctuations in anxiety and salivary cortisol levels due to clinical setting changes and the anxiety associated with clinical practice.

METHODS AND ANALYSIS

This study is an exploratory, cross-sectional, observational study that will be conducted at a health and science school in Portugal. Data collection will involve phycological assessment instruments for personality, anxiety, stress, depression and saliva cortisol levels. The target population consists of undergraduate nursing students enrolled in our institution for the academic year of 2022/2023 (N=272), of whom we aim to recruit 35% (N=96) to the study.

ETHICS AND DISSEMINATION

The project obtained approval from the Institutional Review Board of the Egas Moniz-Cooperativa de Ensino Superior, CRL, on 5 July 2022 (ID: 116/21.22) and ethical approval from the Egas Moniz Ethics Committee on 28 July 2022 (ID:1110.22). Informed consent will be obtained from those who wish to participate, ensuring students' voluntary participation in the project. The results of this study will be disseminated through open-access peer-reviewed publications and presented at scientific events.

The development and study of the effectiveness of a novel uterine contraction learning aid: A two-phase research study

BACKGROUND

Nursing students lack clinical experience in assessing intrapartum uterine activity, rating their ability and level of understanding as low or fair despite receiving theoretical instruction prior to attending clinical placements. Teaching model/aids may facilitate learning, however, purchasing additional models could prove expensive within many organisations. Limited exposure to skills rehearsal in school may contribute to student anxiety, stress, and perceived low self-efficacy when in clinical practice.

OBJECTIVES

To develop and assess the effectiveness of a novel Uterine Contraction Learning Aid as a training tool to expand the knowledge, attitude, and practice of nursing students.

METHODS

A two-phase study conducted at The Institute of Nursing in Thailand. Phase I was underpinned by research and development. After first being considered for its quality, by five experts comprising an obstetrician, two midwives and two nursing instructors, the novel Uterine Contraction Learning Aid was assessed by 30 fourth-year nursing students with experience in assessing uterine contractions for its educational suitability. Phase II - Sixty year-three nursing students were assigned via matched-pairs to either an experimental or control group to evaluate the effectiveness of the Uterine Contraction Learning Aid, completing three questionnaires underpinned by the knowledge, attitude, and practice concept.

RESULTS

Phase I- Descriptive statistics applied to survey responses indicate participants rated the quality of the Uterine Contraction Learning Aid highly in every aspect of learning skills, and perceptions of confidence. The overall production was rated at a good level. Phase II - An independent sample t-test was used to compare knowledge, attitude, and practice values in assessing uterine contractions between control and experimental groups. Participants in the experiment group had significantly higher scores in knowledge and practice when assessing uterine contractions compared to the control group (t = 4.768, p < 0.000 vs. t = 3.630, p < 0.001, respectively). There was no statistically significant difference in attitudes in relation to assessing uterine contractions between the two groups (t = 0.188, p = 0.852).

CONCLUSIONS

The novel Uterine Contraction Learning Aid can be used effectively to prepare nursing students prior to practicing with women undergoing intrapartum care.

An integrative review of resilience among nursing students in the context of nursing education

AIM

This integrative review aimed to examine empirical research on resilience among nursing students in the context of nursing education. Resilience helps nursing students handle challenges, such as changing learning styles and experiencing their first clinical practice.

DESIGN

An integrative review.

METHODS

The search terms focused on resilience and health in nursing students and nursing education. The database used in this review were CINAHL Plus, PubMed and MEDLINE. The Mixed Methods Appraisal Tool appraised the studies' quality.

RESULTS

This study explored 52 records and revealed three current research focuses related to nursing students' resilience: (1) the concept and description of resilience, (2) the characteristics affecting resilience and (3) the mediating role of resilience in maintaining holistic health. Recommendations include adding a resilience topic to the nursing curriculum, providing resilience enhancement programs, examining the relationship between resilience and holistic health and exploring the influence of resilience about global health crises.

PUBLIC CONTRIBUTION

Resilience among nursing students plays a vital role in helping them to overcome adversities during their nursing education. Additionally, after graduation, nursing students can continue contributing to society as resilient Registered Nurses in the future.

Nursing students' experiences and expectations of clinical learning: A qualitative study

BACKGROUND

Clinical learning is an important component of nursing education that can support the development of competence. Nursing students have expectations before clinical learning, however if these expectations are not matched with their experiences, then development can be hampered.

OBJECTIVE

To explore nursing students' expectations and experiences of their clinical learning experiences.

DESIGN

Qualitative descriptive design.

SETTINGS

The study was conducted at a large teaching hospital in Namibia.

PARTICIPANTS

Fifteen first to fourth year undergraduate nursing students who were allocated to a teaching hospital in Namibia.

METHODS

The participants were purposively sampled among the teaching hospital's undergraduate nursing students. Data were collected between June to November 2021 through in-depth, semi-structured interviews that lasted between 35 and 45 min each. Data were analyzed using thematic analysis.

RESULTS

The data analysis identified four themes: clinical outlook and role, supporting/role modelling, clinical teaching and learning, and linking theory and practice.

CONCLUSION

The expectations and experiences of nursing students regarding the clinical environment were mixed. The findings demonstrated the need to moderate students' expectations, as well as to reorganize the clinical learning environment to enhance students' learning. Further studies should look at the standardization of student expectations based on the context of their clinical learning environment, and how this can improve learning experiences.

Prevalence of Stress and Anxiety Among Nursing Students: A Systematic Review and Meta-analysis

BACKGROUND

There is variability in the reported prevalence of stress and anxiety among nursing students across studies, and few studies have investigated the pooled prevalence of stress and anxiety of these students.

PURPOSE

To investigate the prevalence and associated factors related to stress and anxiety among nursing students.

METHODS

Various electronic databases were searched up to October 26, 2022. A random-effects model and a moderator analysis were used to examine the overall prevalence and related factors. Begg's test was adopted to examine publication bias.

RESULTS

In total, 121 studies were included in the meta-analysis. Most nursing students experienced moderate stress (42.1%) and mild to moderate anxiety (19.4%-25.1%). Third- and fourth-year nursing students had severe stress levels compared with those in the first and second years (29.0% vs 15.1%).

CONCLUSIONS

Nurse educators should design appropriate curricula to strengthen student knowledge and provide regular assessments and supportive interventions to reduce stress and anxiety.

Disaster preparedness in healthcare professionals amid COVID-19 and beyond: A systematic review of randomized controlled trials

BACKGROUND

Disasters like COVID-19 are oftentimes inevitable, which makes disaster preparedness indispensable to global health and social stability. However, there is a dearth of understanding of how well healthcare professionals, who often have to work at the epicenter of disasters as they evolve, are trained to be sufficiently prepared for these crises. To this end, this study aims to examine the characteristics and effectiveness of existing interventions that aim to improve healthcare professionals' disaster preparedness.

METHODS

We searched RCTs that aim to improve healthcare professionals' disaster preparedness in databases including PubMed, PsycINFO, CINAHL and Scopus. Results were screened against the eligibility criteria. The review was registered with PROSPERO (CRD42020192517) and conducted following the PRISMA guidelines.

RESULTS

A total of 7382 articles were screened for eligibility, among which, 27 RCTs, incorporating 35,145, met the inclusion criteria. Review results show that most of the eligible RCTs were conducted in high-income countries. Only two RCTs were developed in disaster contexts that share similarities with COVID-19. Most of the interventions did not address critical disaster coping abilities, such as how can healthcare professionals protect or improve their personal or the general public's mental health amid pandemics. Furthermore, almost half of the disaster preparedness RCTs failed to generate statistically significant outcomes.

CONCLUSIONS

Albeit inevitable, disasters are preventable. Our study results underscore the imperative of designing and developing effective and comprehensive interventions that could boost healthcare professionals' disaster preparedness, so that these frontline workers can better protect personal and public health amid global crises like COVID-19.

Factors contributing to depressive symptoms among undergraduate nursing students: A cross-sectional study

AIM

To investigate predictive factors of student's academic year, interest in the field of nursing, stress, self-efficacy, and problem-focused and emotion-focused coping on the depressive symptoms among undergraduate nursing students.

BACKGROUND

As the burden of depression among students has increased worldwide, depressive symptoms have become a standard part of mental health problems in college and university students. Among the various fields of medical sciences, nursing students face more stressors during their study period and are more at risk of suffering depressive symptoms than other students.

DESIGN

A cross-sectional design.

METHODS

A total of 230 undergraduate nursing students from a university in Myanmar were recruited from August to September 2021. The data were collected using standard research instruments, including a Demographic Questionnaire, Student Nurse Stress Index Questionnaire, General Self-efficacy Scale, Brief COPE Inventory, and Center for Epidemiology Studies Depression Scale (CES-D). Descriptive statistics were used to describe the sociodemographic characteristics of the participants. Inferential statistics were used to identify the predictive effect of academic year, interest in the field of nursing, stress, self-efficacy, problem-focused coping, and emotion-focused coping on depressive symptoms, using multiple linear regression analysis.

RESULTS

Academic year, interest in the field of nursing, stress, self-efficacy, and problem-focused and emotion-focused coping accounted for 31.5% of the variance of depressive symptoms (F(8, 221) = 12.704, p < .001) with an R² = .315. Stress was the factor that most influenced student's depressive symptoms (β = .407, p < .001). Self-efficacy (β = -.244, p < .001) and emotion-focused coping (β = .199, p < .05) were also critical factors contributing to depressive symptoms among undergraduate nursing students.

CONCLUSIONS

The results of this study provide insight and knowledge about depressive symptoms and factors that can contribute to depressive symptoms among undergraduate nursing students. Results suggest that nurse educators and community mental health nurses should focus on reducing stress, increasing self-efficacy, and enhancing proper coping strategies among students to prevent depressive symptoms.

Academic burnout in nursing students: An explanatory sequential design

AIM

Despite the harmful effects of burnout among many nursing students, academic burnout is poorly understood. This study was conducted to better explain the concept of burnout in nursing students.

DESIGN

An explanatory sequential mixed-method design was used.

METHODS

In the quantitative phase, the Maslach Burnout Inventory-Student Survey was completed by 91 nursing students in eastern Iran. In the qualitative phase, individual interviews were conducted with 13 undergraduate nursing students, one nurse and one instructor. Data were analysed using the directed content analysis method.

RESULTS

Results from an ANOVA test showed differences in burnout scores in different semesters (p = .02) that were confirmed by the qualitative data. In addition to the three dimensions of the Maslach burnout model (exhaustion, cynicism and inadequacy feeling), qualitative data from the present study indicated the presence of a fourth dimension (incompatible learning style).

Assessment of The Effect of Stress, Sociodemographic Variables and Work-Related Factors on Rationing of Nursing Care

(1) Rationing of nursing care is withholding, limiting or not fulfilling the necessary nursing activities for patients. It may have a negative effect on patient safety and the quality of care. The aim of the present paper is the assessment of the effect of stress on the rationing of nursing care. (2) The current research has a cross-sectional, observational design. The study sample comprised 567 nurses. The following questionnaires were used in the study PIRNCA and PSS-10. (3) It was demonstrated that nurses with a high level of perceived stress rationed nursing care to a greater extent and showed lower assessment of nursing care and lower job satisfaction in comparison with nurses with average and low levels of perceived stress. (4) 1. Stress in nurses has a negative effect on rationing of nursing care and job satisfaction. It is recommended that actions aimed at developing effective stress coping skills be implemented as early as at the stage of training to become a nurse. 2. Factors such as marital status, sex, form of employment, place of employment and the level of professional burnout syndrome may have an influence on the level of experienced stress. In turn, the level of experienced stress, marital status, education, place of work as well as the place of residence may have an effect on rationing of nursing care and, consequently, affect the quality of care.

The Impact of Clinical Training Seminars on Stress and Perception of Clinical Placement Stressors among Spanish Undergraduate Nursing Students: A Two-Phase Mixed-Methods Study

Stress and stressors related to clinical practice are some of the main reasons for the discomfort reported by nursing students. It is important to identify the causes of stress and seek strategies to reduce the stress levels in nursing students. Clinical training seminars have proven to be a useful tool to reduce stress levels. This study aims to evaluate the effects of a series of clinical training seminars on the levels of stress and perception of stress factors before the start of clinical practice among undergraduate Spanish nursing students. A two-phase, sequential mixed-methods design was used. For the quantitative phase, data were collected using Cohen's Perceived Stress Scale and the KEZKAK questionnaire before and after the clinical training seminars. Qualitative data were collected through a focus group session held after the clinical training period. The results show a significant reduction (p = 0.002) in perceived stress levels after the clinical training seminars, and also a change in students' perception of stressors in the clinical placement. This study provides valuable information for the development of content for clinical training seminars. Universities should develop strategies to reduce stress in their students caused by the clinical placement.

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

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

Resilience in nursing education: an evolutionary concept analysis

OBJECTIVES

Resilience is a complex concept that is extensively drawn upon in higher education, nursing included. The objective is to examine the concept of resilience and its use within nursing education.

METHODS

Rodgers' evolutionary concept analysis was used to explore this concept.

RESULTS

The current focus on fostering resilience in undergraduate nursing education predominantly focuses on educational interventions to support one's ability to self-care continues to be pervasive within the nursing literature. More recent dialogue encourages a more holistic approach that examine interventions from both individual and structural perspectives.

CONCLUSIONS

Recommendations for future research are to examine the synergy between individual, contextual, and structural factors to support resilience in nursing students.

IMPLICATIONS FOR INTERNATIONAL AUDIENCE

Based on the concept analysis, resilience is contextual. Therefore, nurse educators may support and foster nursing students' resilience by having increased awareness of both individual and structural perspectives of resilience.

The influence of emotional burnout and resilience on the psychological distress of nursing students during the COVID-19 pandemic

The aim of this study was to measure and analyse the association of emotional burnout and resilience with the psychological distress of students who finished their nursing studies after the peak of the COVID-19 pandemic. The mental health of nursing students was affected during the pandemic, and resilience seems to counteract the negative effects. This is a cross-sectional study. The data (quantitative) were gathered at the beginning of the second term of the academic year 2020/2021. The study was carried out in the Spanish university context. Self-reported measures were gathered using three one-dimensional, valid, and reliable scales: the Psychological Distress Scale (K-10), the Emotional Burnout Scale (EBS), and the short version of the Connor-Davidson Resilience Scale (CD-RISC10). A total of 393 students of different Spanish universities participated in this study. A valid linear regression model was obtained, which allowed verifying that psychological distress is explained, with 37% variance, by emotional burnout and resilience. The total score in emotional burnout has more relevance than the total score in resilience, and the latter has a negative tendency. Facing the factors that generate emotional burnout in students in the academic scope and promoting resilience in them are fundamental aspects that contribute to their psychological well-being. The reflection should be extended to clinical practices. Universities are urged to think about last-year students, their experiences, perceptions, and feelings, to determine how their susceptibility to emotional burnout and psychological distress can be minimized in their future clinical practices. Strategies to promote their resilience should also be studied.

Student Perspectives on Sources of Resilience During Nursing School

Resilience is important to the academic and career success of nursing students; however, the literature on nursing student resilience is sparse and remains undertheorized. This article describes nursing students' perspectives on sources of resilience during nursing school at one institution of higher learning. A constant comparative analysis of baccalaureate nursing student focus group responses was performed. Three themes emerged: negative experiences, supportive structures and relationships, and individual coping processes and abilities. Interrelationships between thematic findings highlight the centrality of supportive structures and relationships. Based on these findings, theoretical guidance for future nursing student resilience assessments and interventions is provided.

Moderating Role of Coping Style on the Relationship between Stress and Psychological Well-Being in Hong Kong Nursing Students

AIMS AND OBJECTIVES

To examine whether coping styles moderate the influence of stressors and psychological well-being in Hong Kong nursing students.

BACKGROUND

Stress could contribute to psychological distress in nursing students. Coping strategies are essential to mitigate psychological distress. So far, the moderating effects of coping between stressors and psychological well-being has not been thoroughly investigated.

DESIGN

This is a cross-sectional study conducted at four higher education institutions in Hong Kong.

METHODS

We recruited a convenience sample of 293 nursing students in February 2018. The Stressors in Nursing Students Scale-Chinese version (SINS-CN), Brief Cope Inventory-Chinese version (Brief COPE-C), and the Chinese version of the General Health Questionnaire-12 (C-GHQ-12) were used to measure the stressors, coping styles, and psychological well-being, respectively. Three multiple hierarchical linear regression models were used to identify the associations between the variables.

RESULTS

The stressors related to clinical learning, confidence, and personal problems were significant in explaining the psychological well-being. The coping strategies also predicted the psychological well-being and explained 44.5% of the variance. The coping strategy-accommodation-moderated the relationship between personal problems and psychological well-being.

CONCLUSION

Problem-solving and accommodation types of coping were adaptive to stress and effective in promoting psychological well-being. However, using accommodation to cope with stressors related to personal problems will exacerbate the negative effects of the personal problems on the psychological well-being.

RELEVANCE TO CLINICAL PRACTICE

This study reveals the relationships between stressors, coping, and psychological well-being. Nurse educators must be aware of nursing student coping styles so they may devise strategies to promote effective coping to reduce the psychological distress among nursing students.

Turkish validity and reliability study of "Nursing Students' perceptions of Clinical Stressors Scale"

BACKGROUND

Clinical education is a significant part of nursing education, but students frequently perceive it as stressful. There is no valid and reliable scale to determine the clinical stressor perceptions of nursing students in Turkey.

OBJECTIVE

The study aims to adapt the "Nursing Students' Clinical Stressor Perceptions Scale" (NSPCSS) into Turkish and perform its validity and reliability study for nursing students.

METHOD

The research was conducted in a methodological design between 30 September 2021 and 1 November 2021. The sample consisted of 304 nursing students.

RESULTS

"The Cronbach's alpha" reliability coefficient of the NSPCSS is 0.912. The retest coefficient is 0.90 and the item correlation values are between 0.404 and 0.689.

CONCLUSION

The study has shown that the NSPCSS-TR is a valid and reliable assessment tool to evaluate clinical stressors in nursing students.

INNOVATE: Preparing Nurses to Be Health Care Innovation Leaders

A new certificate program has been designed that augments the traditional undergraduate nursing education with a curriculum of innovation and entrepreneurship. The goal of the Integrated Innovation & Entrepreneurship Certificate in Nursing Program (INNOVATE) is to empower nurses to collaboratively solve health care challenges and become thought leaders in health care products, technologies, and processes, as well as service and delivery methods, with a particular focus on the needs of vulnerable populations. Toward this goal, INNOVATE is built on an integrative, immersive curriculum, experiential learning, intentional cohort building, peer and faculty support, real-world connections, and the prioritization of diversity, inclusivity, and equity to build of a cohort of nursing students ready for careers in clinical and health care innovation. In this article, we provide the outline for the proposed curriculum, program strategies, anticipated outcomes, and evaluation criteria that we believe can serve as a national model for innovation and entrepreneurship in undergraduate nursing education.