Professional identity in nursing: UK students' explanations for poor standards of care

Identifying the personal characteristics of decent work perception for nursing students in China using latent profile analysis

BACKGROUND

Given the importance of perceptions of decent work for nursing students' future career choices, we attempted to determine potential classifications and characteristics of nursing students' perceptions of decent work so that targeted interventions could be developed.

METHODS

A convenience sample of 1004 s- to fourth-year nursing students completed the General Information Questionnaire, Self-Regulatory Fatigue Scale, Occupational Identity Questionnaire, and Decent Work Perceptions Scale in a cross-sectional survey in Heilongjiang Province, China, resulting in 630 valid questionnaires with a valid return rate of 62.75%. Nursing students' perceptions of decent work were defined using descriptive and regression analysis.

RESULTS

Latent profile analysis (LPA) identified three subgroups: low perceived decent work group, medium perceived decent work group, and high perceived decent work group, accounting for 4.76%, 69.37%, and 25.87% of the sample, respectively. The results of unordered multiclass logistic regression show that nursing students with relatively low levels of perceived decent work are more likely to have a low professional identity, a lack of respect for nursing seniors, an involuntary choice of nursing major, and a low family income.

CONCLUSION

Different types of nursing students have different perceptions of decent work, and these universities and related departments can use different educational guidance strategies.

Interrogation in clinical supervision sessions: Exploring the construction of clinical psychology trainees’ professional identities

BACKGROUND

Professional socialisation is a complex process through which learners become healthcare professionals. This process occurs in relational spaces: learners are exposed to norms and expectations of them in interactions during formal and informal learning activities. Research exploring socialisation into the healthcare professions is extensive yet inadequately captures details of the actual processes of socialisation and forming of professional identity. Our study offers a moment-by-moment examination of clinical psychology trainee supervision to provide a deeper exploration of novice healthcare professionals' identity development within formal educational interactions.

AIMS

We sought to explore how, and in what ways, supervision interactions impact clinical psychology trainees' professional identity development.

METHOD

Our data comprises 12 audio recordings of supervisor-trainee interactions in a clinical psychology training clinic. Initial data engagement identified 20 instances of interrogation instigated by supervisors (i.e., repetitive questioning, enquiry) as being key events in which identities are contested and re-negotiated. These sections were transcribed verbatim. Drawing on positioning, framing and impression management theories, we explored identity construction in interrogations using discourse analysis.

RESULTS

Supervisors approached interrogations of trainees from either a quality control or a reflective frame focusing on the client or trainee respectively. These frames influenced the positions being made available to trainees. Reflective frame interrogations often defaulted back to quality control. Trainees employed impression management tactics to manage perceived face-threat.

DISCUSSION

Findings highlight challenges with maintaining a reflective space in supervision during interrogations. Supervisors had authority to initiate interrogations that could be taken up, negotiated or resisted by trainees, ultimately maintaining certain professional knowledge and truths. We illuminate the ways in which socialisation processes at the interactional level during formal learning activities ultimately make available (and restrict) certain ways for trainees to think, feel and be.

Development of emotional intelligence and assertiveness in physiotherapy students and effects of clinical placements

BACKGROUND

Emotional intelligence (EI) and assertiveness are key abilities for physiotherapists. Clinical placements seem to affect students' development of EI and assertiveness, and their construction of the professional role.

PURPOSE

This study aims to compare the EI of physiotherapy students with students from other health professions and explore the evolution of EI and assertiveness in physiotherapy students throughout their university education, focusing on the influence of clinical practice.

METHOD

Students (N = 753) completed a self-administered questionnaire to measure emotional intelligence (TMMS 24), assertiveness (CSES), and sociodemographic variables.

RESULTS

EI levels were adequate and very similar across the three disciplines. Regarding assertiveness, physiotherapy students in year 4 obtained significantly higher levels than students in years 1, 2, and 3. Significant correlations (rs (207) = 0.35, p < .001) were found between assertiveness and the number of modules of clinical practice.

CONCLUSION

This study contributes with further evidence on the improvement of assertiveness in physiotherapy students through their university education and, in particular, with clinical placements. Practical implications highlight the importance of training in EI and assertiveness during university, coupled with clinical placements, in order to prepare for an effective and satisfactory professional life.

The use of LEGO® SERIOUS PLAY® within nurse education: A scoping review

OBJECTIVES

The purpose of this review is to map how LEGO® SERIOUS PLAY® is currently utilised within education and to explore the benefits it may offer to the education of new nurses.

DESIGN

A scoping review which utilises a 5 stage methodological framework in order to encapsulate a broad range of evidence relating to the use of LEGO® SERIOUS PLAY® within a variety of educational settings.

DATA SOURCES

Databases searched included CINAHL, Academic Search Premier, PsychInfo, Scopus as well as Proquest Dissertations and Theses and the British Library's Electronic Theses Online Service. Additional sources were also sought through review of the reference lists of relevant articles.

REVIEW METHODS

Retrieved articles were screened for relevance and compiled in a charting table to summarise the key components and findings of each source. Qualitative content analysis was then utilised to address the identified review questions.

RESULTS

A total of 11 texts were reviewed consisting of 1 conference paper, 6 research reports and 4 conceptual articles. These explored the use of LEGO® SERIOUS PLAY® across a broad range of disciplines including nursing, play therapy, occupational therapy and marketing.

CONCLUSIONS

The scoping review highlights that LEGO® SERIOUS PLAY® offers a number of benefits that can be utilised within nursing education, particularly in relation to supporting reflection, formation of professional identity and the development of resilience. These results highlight a gap in the evidence concerning the use of LEGO® SERIOUS PLAY® within nursing education and thus the need for further exploration.

Transformative learning experience among nursing students with patients acting as teachers: Mixed methods, non-randomized, single-arm study

AIM

To examine the effects of expert HIV patients acting as teachers to Spanish nursing students both on their HIV-related knowledge, attitudes and practices and on their approach to the care model as well as to explore their learning experience.

DESIGN

Non-randomized, single-arm study with quantitative before and after measurements and qualitative data.

METHODS

The intervention consisted of five 90-min workshops led by two women living with HIV. Thirty-four nursing students participated, and quantitative and qualitative data were gathered from February to June 2018. We used the Patient-Practitioner Orientation Scale (PPOS) and the KAP questionnaire on HIV/AIDS to collect quantitative data.

RESULTS

Statistically significant differences were found in the global score for care orientation and its two dimensions, caring and sharing. About the changes resulting from the workshops, the quantitative results-more patient-centred care perception and better attitudes towards people living with HIV-match the qualitative findings in all the aspects studied, except in sharing.

CONCLUSION

Incorporating expert patients as teachers in the nursing bachelor's degree resulted in more patient-centred care and improved knowledge, attitudes and practices. The workshops conducted by qualified expert patients showed transformative learning power, as the participants improved professional and personal aspects.

Clocking out: Nurses refusing to work in a time of pandemic

Social science research has long critiqued how professional ideals of public service can ignore chronic problems within the healthcare industry, placing unfair burden on the "heroism" of individual workers. Yet, fewer studies investigate how healthcare professionals actively negotiate such demands for service, amidst increasing workplace pressures and risks. This paper studies Filipino nurses' response to a government policy that banned them from working overseas in order to channel their labor to local hospitals during the COVID-19 pandemic. Based on 51 in-depth interviews, we argue that nurses' willingness to serve in the Philippines' COVID-19 hospitals hinged on the point at which the deployment ban interrupted their emigration trajectories. Specifically, nurses' decision to heed their government's call to service depended on whether they saw local hospital experience as valuable for their plans of working abroad. We introduce the concept of "clocking out" to describe how aspiring nurse migrants set limits to the time they devote to local service, as they pursue a career pathway beyond national borders. We discuss how this concept can inform scholarship on nurse retention and professional values, especially for developing nations in times of crisis.

Facilitators of professional socialisation of learners in the clinical learning areas: A qualitative systematic review

Background

Professional socialisation is significant in nursing as it involves immersing learners in the profession so that they adopt the ethical values and conduct of the profession. It is in the clinical learning areas where learners observe and practise those values. The objective of the review was to explore the factors that promote professional socialisation of learners in the clinical learning areas. The problem is the inadequate support for learner nurses in the clinical learning areas. The South African community has lost trust in nurses and that was even acknowledged in the national nursing summit in 2011.

Objectives

To present a review of the factors that facilitate professional socialisation among undergraduate nursing learners.

Method

A systematic review was conducted on literature from 2008 to 2018. The literature search focused on factors that facilitate professional socialisation of learner nurses. A search of databases was conducted in CINAHL, MEDLINE, Google Scholar and Science Direct. The search focused on literature on professional socialisation of learner nurses published from 2008 to 2018. The search resulted in 3035 articles which were further reduced to 13 after further synthesis. Critical appraisal skills programme was used to assess the quality of the studies.

Results

Three main themes emerged. Learner factors, factors in the clinical learning areas and interpersonal factors were identified as the factors that facilitate professional socialisation of learners.

Conclusion

Learners should have self-motivation and be supported and assisted to develop a positive professional identity. The clinical learning environment should have effective communication that fosters learning. Professional nurses should act as exemplary role models so that learners can emulate the conduct and practice. The review brought to light that the professional socialisation of learners is affected by the learner factors, clinical learning areas and personal factors.

Professional identity, wellness, and future hope among nurse interns in Egypt

Objective

Since nursing is a performance-based profession, clinical learning environments play an important role in the acquisition of professional abilities and train nursing students to enter the nursing profession and become a registered nurse. The study aimed to investigate the relations among professional identity, wellness, and future hope in nurse interns.

Methods

A cross-sectional, analytic, descriptive, correlational study design was used to test these relations in the study where 210 nurse interns’ students were selected using a convenience sampling from Zagazig University hospitals and Suez Canal University hospitals in Egypt. The questionnaires consisted of 4 parts, namely demographic characteristics, Professional Identity Scale for Nursing Students (PISNS), Holistic Health and Wellness Survey, and Hope scale.

Results

Less than half of the study sample had chosen nursing specialty by own will (43.8%), while slightly more than half of them had a “very good” graduation level, and had no nursing role model. The lowest mean professional identity score was for independence in career choice while the highest was for social modeling. The reported physical wellness mean-score was the least, while social wellness was the highest. Professional identity, wellness, and future hope scores differed significantly based on nurse interns’ personal characteristics. There were statistically significant, positive, weak-to-moderate correlations among the scores of professional identity, wellness, and future hope; however, the “choice of nursing study by own will” was a statistically significant independent positive predictor of the scores of professional identity, wellness, and future hope.

Conclusions

Nurse interns’ professional identity, wellness, and future hope were positively inter-correlated. However, nurse interns’ wellness was the lowest, and it should be fostered as it was the main predictor for future hope. The internship programs should be modulated to improve nurse interns’ professional identity, particularly regarding independence, and should foster their well-being in the clinical environment.

Effects of Self-Esteem, Problem-Solving Ability, and Professional Nursing Values on the Career Identity of Nursing College Students in South Korea: A Cross-Sectional Study

In Korea, the number of admissions to nursing colleges has greatly increased over the past 20 years to address the shortage of nurses. However, many nursing students have unclear career identities during college and stop working in healthcare after graduation. This study aimed to examine the effects of self-esteem, problem-solving ability, and professional nursing values on career identity. The participants were 140 third- and fourth-year nursing students recruited from a university in South Korea. Data were collected between September and October 2019 using a self-administered questionnaire. Data were analyzed using descriptive statistics, t-test, ANOVA, Pearson’s correlation, and multiple linear regression. The results showed significant correlations between satisfaction with college life and major subject, subjective academic achievement, self-esteem, problem-solving ability, professional nursing values, and career identity. The factors that significantly affected career identity were self-esteem and professional nursing values. Nursing educators can support the career development of nursing students by enhancing their self-esteem and professionalism, along with efforts to improve satisfaction with their college life and major.

The effect of group-dynamics, collaboration and tutor style on the perception of profession-based stereotypes: a quasi-experimental pre- post-design on interdisciplinary tutorial groups

BACKGROUND

Group processes in inter-professional Problem-Based Learning (iPBL) groups have not yet been studied in the health-care educational context. In this paper we present findings on how group-dynamics, collaboration, and tutor style influence the perception of profession-based stereotypes of students collaborating in iPBL groups. Health-care students are trained in iPBL groups to increase their ability to collaborate with other healthcare professionals. Previous research focusing iPBL in healthcare implies that more systematic studies are desired, especially concerning the interaction between group processes and internalized professional stereotypes. The aim of this study is to investigate whether changes in group processes, collaboration, and tutor style, influence the perception of profession-based stereotypes of physician- and nursing-students.

METHODS

The study is a quasi-experimental pre- post-design. The participants included 30 students from five different healthcare professions, mainly medicine and nursing. Other professions were physiotherapy, occupational therapy and speech therapy. The students were divided into four iPBL groups, each consisting of six to nine students and a tutor. Data were collected through systematic observation using four video-recorded tutorials. SPGR (Systematizing the Person Group Relation), a computer-supported method for direct and structured observation of behavior, was used to collect and analyze the data.

RESULTS

Traditional stereotypical profession-based behaviors were identified in the first observed group meeting. Although the groups followed different paths of development, the group-dynamics changed in all groups over the 6 weeks of collaboration. Two of the groups became more cohesive, one became more fragmented and one became more polarized. Stereotypical behaviors became less frequent in all groups. Our findings indicate that tutor behavior has a strong influence on the development of the group's dynamics.

CONCLUSION

Our findings strongly suggest iPBL is a means of reducing stereotypical behaviors, and may positively increase members' ability to engage in inter-professional collaboration. Although the pattern of dynamics took different forms in different groups, we argue that iPBL forces students to see the colleague behind his or her profession, thus breaking professional boundaries. The tutor style significantly influenced the iPBL groups' development. This study contributes to our field by emphasizing the effect of group-processes in increasing mutual understanding across professions.

The knowledge about patient safety among undergraduate nurse students in Cyprus and Greece: a comparative study

BACKGROUND

The Patient safety movement contributed to the reduction of preventable adverse events associated with health care. Although patient safety issues have received the attention of educators in the health care studies, there is evidence that in nursing education and the associated curricula it is not well-incorporated. This may not allow students to acquire scientific knowledge and develop strong competencies to assure patient safety throughout their professional life. The aım of the study was the exploration of the undergraduate nursing student perspectives regarding knowledge received during their training about patient safety-related issues.

METHODS

A descriptive comparative study was conducted with three and four-year undergraduate nursing students from the Cyprus Republic (n = 243) and Greece (n = 367). All students were surveyed using the Health Professional Education Patient Safety Survey (H-PEPSS) to describe students' knowledge in the classroom and clinical setting.

RESULTS

Students' Knowledge about patient safety was expressed significantly higher (p < 0.001) in the classroom (mean = 4.0) than the clinical setting (3.7) (1-5 scale). The knowledge in the dimension "clinical aspects" received the highest score and "working in teams" received the lowest. Also, differences were recorded between countries wıth Cypriot students reporting hıgher level of knowledge than the Greek students in most of the dimensions. CONCLUSıON: The findings revealed the gap between theory and practice and the need for collaboration between the two settings. Also, students reported relatively higher knowledge with regards to the technical aspects of patient safety. Still, they were less knowledgable about the sociocultural aspects of the patient, such as working in teams.

Influences of nursing students' career planning, internship experience, and other factors on professional identity

BACKGROUND AND OBJECTIVE

Nursing professional identity is an important factor in the development of nursing education and clinical practice. Career-planning curriculums enable students to learn relevant knowledge and skills in a targeted manner, in addition to achieve career targets. Assessment and analysis of the present situation of Chinese nursing students' career planning and professional identity may provide an important guidance for the improvement of teaching content and quality of the career-planning curriculum. This study aimed to describe nursing students' professional identity, and to find out influences of nursing students' career planning, internship experience, and other factors on professional identity.

METHODS

A descriptive cross-sectional research method was employed to conduct a questionnaire on 453 full-time junior and senior undergraduate nursing students in China in December 2019.

RESULTS

The average score for nursing students' professional identity was 101.42, which is at a moderately low-level. There was a significantly positive correlation between the level of nursing students' career planning and professional identity (r = 0.529, P < 0.01). Nursing students' professional identity was also influenced by grade, age, acceptance of career-planning curriculums, and other factors.

CONCLUSION

The results indicated that the level of professional identity in nursing students is closely associated with their career planning. One strategy to improve this situation is to motivate universities to pay further attention to the effectiveness of career-planning curriculums and, to improve the quality of teaching and guidance system.

Making the case for clinical mental health nurses to break their silence on the healing they create: A critical discussion

This discursive paper aims to clarify what roles mental health nurses identify as being within their scope of practice in clinical settings. It also aims to highlight any consumer benefits arising from these roles. Role theory and its relationship with identity are critically discussed as a framework to explain how contemporary mental health nursing roles are poorly understood and undervalued within mental health services. In order to meet the aims of the paper literature written in the last five years by clinical mental health nurses reporting their roles, and outcomes of those roles were searched. This literature was then considered through the lens of social constructionism that premises truths are accessed and then constructed though relationship based language. Six core mental health nursing roles were identified across international settings. The MHN is a psychotherapist. The MHN is a consumer advocate. The MHN is a physical health therapist. The MHN is a psycho-pharmacological therapist. The MHN is a relationship focussed therapist and finally the MHN is an aggression management therapist. While European and American nurses reported consumer benefit emerging from these roles those from Australia and the United Kingdom did not. The roles reported on were largely instrumental ones that offered little clarity towards the identity of our profession, nor its worth to consumers or funders of services. Mental health nurses will only have their true breadth of clinical capabilities recognized where there is a consistent construction emerging from clinicians in clinical settings on the efficacy of their clinical work.

Moral distress: A theorized model of influences to facilitate mitigation and resilience

Moral distress results from the threat to professional moral integrity and identity. This phenomenon is well documented in nursing literature. Persistent and unresolved moral distress is frequently linked to high nursing staff turnover and shortages. Engagement in a structured hermeneutic critical reflective process facilitated identification of micro, meso, and macro factors influencing the experience of moral distress. Following this process, a theorized model was developed to illustrate interactions between influences contributing to the experience of moral distress in nurses. The model highlights where opportunities lay to take action to avoid or minimize the negative consequences of this phenomenon. Professional resilience is achieved via the conscientious development of professional identity and practice of critical reflection, as components of enculturation of nurses into the profession. Undergraduate and further nurse education activities must focus on developing the necessary attitude, confidence, and skills to address issues in practice which contribute to the experience moral distress to build resilience.

Professional Identity in Graduating Nursing Students

BACKGROUND

This research examines the meaning of nursing professional identity development from the perspectives of both associate degree nursing students and baccalaureate degree nursing students in their final semester. It provides insight into the student's understanding of nursing professional identity and the factors students identified as supporting or detracting from it.

METHOD

Participants were guided through individual interviews using semistructured interview questions and later invited to focus groups with other students to clarify and elaborate on previous comments.

RESULTS

Results demonstrated both groups shared many descriptions of what it means to be a nursing professional, including knowledge, caring, team-work, and integrity. Good communication, confidence, competence, critical thinking, advocacy, and leadership were concepts the participants frequently used to describe the professional nurse.

CONCLUSION

This research helps to further the understanding of this significant topic in nursing education and to serve as a basis for student activities that help foster nursing professional identity formation. [J Nurs Educ. 2021;60(2):74-80.].

Being a real nurse: A secondary qualitative analysis of how public health nurses rework their work identities

Many Western nations are emphasizing the importance of population health across health care delivery organizations and education systems. Despite significant momentum to integrate population health into nursing practice, a parallel effort to examine how these efforts impact practicing nurses' views of their professional role and work identity has not occurred. This secondary qualitative analysis, employing an abductive approach, explored processes public health nurses use in creating and maintaining their work identity through three organizing themes: narrative self-identity, mandated identity, and identity as struggle. The analysis was based on interview data collected from 30 US public health nurses residing in 17 states. 'Being a real nurse' describes public health nurses' efforts to balance a contradictory work identity where at times they are expected to focus on populations and at other times, on individuals. The identity work revealed through this study should be further explicated and specific strategies developed for stabilizing a work identity for public health nurses, as well as for any nurse charged with a population health role.

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

OBJECTIVE

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

METHOD

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

RESULTS

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

CONCLUSION

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

Effectiveness of empathy clinical education for children's nursing students: A quasi-experimental study

BACKGROUND

Empathy is a central competence for nursing students in delivering compassionate care. Empathy training might improve the communication skills in children's nursing students.

OBJECTIVES

To evaluate the effectiveness of the Knowledge, Simulation, and Sharing training programme on empathy skills among children's nursing students.

DESIGN

A controlled pre-post intervention study with a quasi-experimental design.

SETTING

Tertiary children's hospital in China.

PARTICIPANTS

Children's nursing students (n = 250) in clinical internship.

METHODS

A Knowledge, Simulation, and Sharing (KSS) module related to empathy learning was developed and tested during a 10-month period in 2017. Nursing students were divided into an experimental group (n = 125) and control group (n = 125). Both groups received the standard internship programme. The experimental group received the KSS training. Outcome measures were: Jefferson Scale of Empathy-Health Professions Student, Clinical Communication Competence Scale and Professional Identity Scale.

RESULTS

At the end of the internship the experimental groups had significantly higher empathy scores than the control group (114.57 versus 110.36; p = .016). The communication skills improved significantly in the experimental group after the training; experimental group mean 90.22 versus control group mean 87.41 (p = .042). The professional identity scores were significantly higher in the experimental group at the end of the internship compared to the control group (mean 116.43 versus 107.68; p < .001). Subgroup analysis revealed only significant differences on professional identity outcomes between experimental and control groups on diploma level (mean 115.78 versus 107.72; p < .001); and bachelor's level (mean 120.05 versus 108.00; p < .016).

CONCLUSION

The KSS training can enhance empathy and communication skills and the professional identity in children's nursing students. Further long-term effectiveness of the training needs to be tested, ideally with reported outcomes measures of children and parents.

The hidden curriculum: Undergraduate nursing students' perspectives of socialization and professionalism

BACKGROUND AND AIM

Nursing students form a professional identity from their core values, role models, and past experiences, and these factors contribute to the development of their professional identity. The hidden curriculum, a set of ethics and values learned within a clinical setting, may be part of developing a professional identity. Nursing students will develop a professional identity throughout school; however, their identity might be challenged as they attempt to balance their core values with behaviors learned through the hidden curriculum. The purpose of this project was to educate students on the hidden curriculum in the development of their professional identity.

MATERIALS AND METHODS

A sample of 112 senior nursing students was recruited from a northeastern university in the United States for this study. Pre-post survey design was used, and an educational session was administered prior to the post-survey. Descriptive statistics and a valid percentage were used to describe the data within the surveys.

ETHICAL CONSIDERATION

Study was approved by the author's University Institutional Review Board.

FINDINGS

A significant finding was for advocacy as students would speak up if witnessing inappropriate behavior toward patients or families with a mean score increase from 2.50 (pre-survey) to 1.45 (post-survey). Also, over 95% (n = 106) found the educational session beneficial as they learned they had the ability to advocate and speak up for their patients.

CONCLUSION

Students were able to use their core values and advocate for their patients and families which allows for safer patient care.

Professional transition and identity formation of surgical care practitioners: a phenomenological interpretation of their lived experiences

Surgical care practitioners are non-medical members of the surgical team, who provide direct surgical care to patients, delegated by consultant surgeons. The surgical care practitioners' professional role is within the new non-medical or nursing workstream, practising under the medical model of care in response to staff shortages and the rising expectations that are affecting the National Health Service. This article seeks to contribute to a better understanding of the phenomenon of the emergent professional identity of surgical care practitioners. Six surgical care practitioners were purposively sampled for in-depth, semi-structured interviews whereupon their concepts of professional transition and professional identity formation from their individual points of view were explored using a phenomenological approach. Transcripts and reflective texts were subject to repeated interpretation in a hermeneutic circle of understanding. Interpretation of the results in context allowed for a discussion informed by self-interpreted constructions and revolved around eight cluster themes that emerged explicating how surgical care practitioners experienced professional transition and professional identity formation. In addition, a notion of 'journey' in the development of professional identity (narratives about professional identity formation: the hero's journey) was embedded in the reflections of the participants and their narratives produced rich accounts of the phenomenon under investigation.

Failure to report poor care as a breach of moral and professional expectation

Cases of poor care have been documented across the world. Contrary to professional requirements, evidence indicates that these sometimes go unaddressed. For patients, the outcomes of this inaction are invariably negative. Previous work has either focused on why poor care occurs and what might be done to prevent it, or on the reasons why those who are witness to it find it difficult to raise their concerns. Here, we build on this work but specifically foreground the responsibilities of registrants and students who witness poor care. Acknowledging the challenges associated with raising concerns, we make the case that failure to address poor care is a breach of moral expectation, professional requirement and, sometimes, legal frameworks. We argue that reporting will be more likely to take place if those who wish to enter the profession have a realistic view of the challenges they may encounter. When nurses are provided with robust and applied education on ethics, when "real-world" cases and exemplars are used in practice and when steps are taken to develop and encourage individual moral courage, we may begin to see positive change. Ultimately however, significant change is only likely to take place where practice cultures invite and welcome feedback, promote critical reflection, and where strong, clear leadership support is shown by those in positions of influence across organisations.

Is research on professional identity formation biased? Early insights from a scoping review and metasynthesis

OBJECTIVE

Despite a recent surge in literature identifying professional identity formation (PIF) as a key process in physician development, the empiric study of PIF in medicine remains in its infancy. To gain insight about PIF, the authors examined the medical literature and that of two other helping professions.

METHODS

The authors conducted a scoping review and qualitative metasynthesis of PIF in medicine, nursing and counselling/psychology. For the scoping review, four databases were searched using a combination of keywords to identify empiric studies on PIF in trainees. After a two-step screening process, thematic analysis was used to conduct the metasynthesis on screened articles.

RESULTS

A total of 7451 titles and abstracts were screened; 92 studies were included in the scoping review. Saturation was reached in the qualitative metasynthesis after reviewing 29 articles.

CONCLUSION

The metasynthesis revealed three inter-related PIF themes across the helping professions: the importance of clinical experience, the role of trainees' expectations of what a helping professional is or should be, and the impact of broader professional culture and systems on PIF. Upon reflection, most striking was that only 10 of the 92 articles examined trainee's sociocultural data, such as race, ethnicity, gender, sexual orientation, age and socio-economic status, in a robust way and included them in their analysis and interpretation. This raises the question of whether conceptions of PIF suffer from sociocultural bias, thereby disadvantaging trainees from diverse populations and preserving the status quo of an historically white, male medical culture.

Role-modelling and the hidden curriculum: New graduate nurses' professional socialisation

AIMS AND OBJECTIVES

To explore new graduate nurses' experiences of professional socialisation by registered nurses in hospital-based practice settings, and identify strategies that support professional identity development.

BACKGROUND

Professionalism is reinforced and stabilised in the clinical environment through the "hidden curriculum", with major learning coming from practice role-models. New graduates observe attitudes, behaviours, decision-making and skills, and gain feedback from registered nurses, which they translate into their own practice. Professional socialisation occurs through encounters with desirable and undesirable role-modelling; both are significant in professional identity formation.

DESIGN

Qualitative descriptive design.

METHOD

Data collection was undertaken through semistructured interviews with five new graduate nurse participants. A general inductive approach guided analysis. The meaningful descriptions gained provided insight into their experiences.

RESULTS

Three main themes identified from the data include: "Lessons from the wilderness"; "Life in the wild"; and "Belonging to a wolf pack". The data set highlighted the major transitional process from student identity to registered nurse.

CONCLUSIONS

New graduates' rethinking of beliefs and professional nursing identities were influenced by organisational pressures and experienced nurses' role-modelling practices contrary to professional values. Despite encountering a range of professional behaviours, attitudes and dilemmas, new graduates were capable of moral agency and critical thinking. However, they rapidly acculturated and described compromises to cope. To promote high morale and a sense of belonging, a concerted effort is required by all nurses to facilitate the socialisation process to encourage self-authorship.

RELEVANCE TO CLINICAL PRACTICE

A well-developed professional identity enhances nursing as a profession, contributing towards better healthcare delivery and outcomes. It is critically important how professional values are learnt within the culture of nursing. Tensions in clinical practice need to be understood better to avoid moral distress caused by dissonance between expectation and experience. It is advantageous to increase early positive socialisation.

Caring characters and professional identity among graduate nursing students in China-A cross sectional study

BACKGROUND

Caring is recognized as the essence of nursing and the core of nursing practice while a positive professional identity can lead to personal, social and professional fulfillment. Analyzing caring characters and professional identity yields important indications for the improvement of teaching methods. This study aims to explore the graduate nursing students' professional identity and caring characters in China, and analyze their correlation.

METHOD

A descriptive cross-sectional study was used to collect data from 216 graduate nursing students between January and February 2017 in China.

RESULTS

Graduate nursing students perceived they possessed positive caring characters while their professional identity was at a low level. A significant positive correlation was found between the Nursing Caring Characters Assessment Tool and Professional Identity Scale for Nursing Students.

CONCLUSION

Graduate nursing students' professional identity was not satisfactory and one strategy to improve this is to internalize caring into the education process. Nursing educators should focus more on the formation of the students' professional identity and caring as a contributing factor to it.