Nursing students’ perceptions and experiences of reflective practice: A qualitative meta-synthesis

Developmental trajectories of professional preparedness among senior nursing students during clinical placement: A longitudinal study

BACKGROUND

Newly graduated nurses' lack of professional competence is associated with inadequate preparation during their clinical placement as nursing students. Clinical placement is a critical stage in the development of nursing students' professional preparedness. However, research on the trajectory of nursing students' professional preparedness during clinical placement has not yielded findings with the same specificity.

OBJECTIVES

The aim of this study is to estimate differences in professional preparedness levels at different clinical placement stages, to identify distinct patterns of professional preparedness trajectories during clinical placement, and to evaluate predictors of these trajectory group memberships.

DESIGN

A quantitative longitudinal study.

SETTINGS

Participants were recruited on a voluntary basis using convenience sampling at a tertiary hospital in Nanning, China.

PARTICIPANTS

224 senior nursing students were initially invited to participate in the study. A total of 178 nursing students successfully completed the follow-up assessments at baseline, as well as at 1 month, 4 months, and 8 months into their clinical placement.

METHODS

Participants completed four online surveys, during which their professional preparedness level was measured using the Perceived Professional Preparedness questionnaire for senior nursing students. Professional preparedness scores at different time points were compared using one-way repeated measures ANOVA and latent growth model. Group-based trajectory model was applied to identify professional preparedness trajectories. Multiple logistic regression was adopted to determine the predictors of trajectory group memberships.

RESULTS

The entire sample of Senior nursing students experienced a significant increase in professional preparedness during clinical placement. The best-fitting group-based trajectory model delineated three distinct trajectories: low-slowly increase trajectory (27.53 % of sample), moderate-rapidly increase trajectory (47.19 % of sample) and a high-stably increase trajectory (25.28 % of sample). Male, good and excellent academic performance, and very high degree of professional interest are the predictors of the moderate-rapidly increase trajectory. While male, good and excellent academic performance, high and very high degree of professional interest and participating in medical-related part-time employment are the predictors of the high-stable increase trajectory.

CONCLUSIONS

Senior nursing students exhibit different levels of professional preparedness throughout their clinical placement. Simultaneously, three different trajectories were identified among the sample of nursing students. Therefore, in future research, greater attention should be directed towards the professional preparedness levels of nursing students with different trajectories, and early identification and targeted interventions should be prioritized.

Building Confidence, Diminishing Stress: A Clinical Incivility Management Initiative for Nursing Students

OBJECTIVE

The aim of this study was to evaluate the effectiveness of an interactive program designed to reduce nursing students' perceived stress and improve self-efficacy and readiness to professionally address incivility during clinical practice.

BACKGROUND

Incivility in clinical settings adversely impacts learners, educators, institutions, and healthcare systems, undermining safety and the teaching-learning process. Despite its increasing global prevalence, effective interventions remain largely unexplored.

METHODS

Our mixed-methods study, conducted from March to April 2024, involved senior baccalaureate pre-licensure nursing students (N = 35) from a California State University. The three-week, one-hour-per-week, interactive clinical incivility management program was developed through an extensive literature review. Pre- and post-intervention differences were assessed using a 10 min self-administered online survey that included the Uncivil Behavior in Clinical Nursing Education (UBCNE; 12 items), Perceived Stress Scale (PSS; 10 items), General Self-Efficacy Scale (GSE; 10 items), and a sample characteristics questionnaire (11 items). A one-hour face-to-face focus group (n = 11) then provided qualitative data on personal experiences of clinical incivility. Quantitative data were analyzed using SPSS version 27, while qualitative data were analyzed using Colaizzi's method.

RESULTS

Clinical incivility prevalence was 71.4% (n = 25 out of 35). No statistically significant differences were found in UBCNE, PSS, and GSE scores between pre- and post-intervention. However, professional responses to clinical incivility significantly improved after the intervention (t = -12.907, p < 0.001). Four themes emerged from the qualitative data: (a) uncivil behaviors or language from nurses, (b) emotional discouragement and low self-confidence, (c) resource and personnel shortages at clinical sites for education, and (d) the necessity for interventions to manage clinical incivility.

CONCLUSIONS

Nursing schools and clinical agencies should collaborate to establish monitoring systems, enhance communication, and implement evidence-based policies and interactive interventions to prevent and manage clinical incivility experienced by nursing students from clinical sites.

Ensuring robust OSCE assessments: A reflective account from a Scottish school of nursing

AIM

This paper reflects on the experience of one Scottish University in conducting a face-to-face Objective Structured Examination (OSCE) for large cohorts of student nurses. It outlines the challenges experienced and learning gained. Borton's model of reflection frames this work due to its simplicity, ease of application and cyclical nature.

BACKGROUND

The theoretical framework for the OSCE is critical thinking, enabling students to apply those skills authentically. OSCE's are designed to transfer classroom knowledge to clinical practice and offer an authentic work-based assessment.

DESIGN

Validity and robustness are key considerations in any assessment and in OSCE, the number of stations that students encounter is important and debated. We used a case-study based OSCE approach initially over four stations and following reflection, changed to one long station with four phases.

RESULTS

In OSCE examinations, interrater reliability is a necessity, and students expect equity of approach. We identified that despite clear marking criteria, marks were polarised, with students achieving high or low marks with little middle ground. Review of examination papers highlighted that although students' overall performance was good, some had failed in at least one station, suggesting a four-station approach may skew results. On reflection we hypothesised that using a one station case study-based, phased approach enabled the examiner to build up a more holistic picture of student knowledge and skills. It also provided the student opportunity to develop a rapport with the examiner and standardised patient, thereby putting them more at ease. We argue that this approach is holistic, authentic and student centred.

CONCLUSIONS

Our experience highlights that a single station, four phase OSCE is preferrable, enabling students to integrate all aspects of the assessment and provides a holistic view of clinical skills and knowledge.

Teaching Social Determinants of Health in Nursing Programs: An Integrative Review of Strategies and Effectiveness

BACKGROUND

Incorporating social determinants of health (SDoH) into clinical decision-making can clarify disease causes, enhance care planning, and improve health outcomes. Nurse educators should know which strategies are most effective for teaching SDoH in bachelor of science in nursing (BSN) programs.

OBJECTIVE

This integrative review synthesizes the literature on familiarizing BSN students with SDoH and identifies effective teaching interventions for SDoH in these programs.

METHODS

The researchers searched CINAHL, PubMed, Web of Science, and ERIC databases, and 21 articles met the inclusion criteria. The PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analysis) guidelines were followed for reporting.

RESULTS

The curriculum method, service learning, and international outreach experiences were frequently used teaching strategies. Qualitative evaluation was used to evaluate student outcomes.

CONCLUSIONS

Nurse educators should be mindful of these strategies. Interdisciplinary teamwork can bolster students' understanding of disadvantaged populations while integrating SDoH in nursing curricula. Quantitative evaluations of learning outcomes are needed to determine teaching effectiveness.

Usefulness of pedagogical design features of a digital educational resource into nursing home placement: a qualitative study of nurse educators' experiences

BACKGROUND

The rapid advancement of technology-enhanced learning opportunities has resulted in requests of applying improved pedagogical design features of digital educational resources into nursing education. Digital educational resources refers to technology-mediated learning approaches. Efficient integration of digital educational resources into nursing education, and particularly into clinical placement, creates considerable challenges. The successful use of digital educational resources requires thoughtful integration of technological and pedagogical design features. Thus, we have designed and developed a digital educational resource, digiQUALinPRAX, by emphasizing pedagogical design features. The nurse educators' experiences of the usefulness of this digital educational resource is vital for securing improved quality in placement studies.

AIM

To obtain an in-depth understanding of the usefulness of the pedagogical design features of a digital educational resource, digiQUALinPRAX, in supporting nurse educators' educational role in nursing home placements in the first year of nursing education.

METHODS

An explorative and descriptive qualitative research design was used. Individual semi-structured interviews were conducted with six nurse educators working in first year of a Bachelor's of Nursing programme after using the digital educational resource, digiQUALinPRAX, during an eight-week clinical placement period in nursing homes in April 2022.

RESULTS

Two main categories were identified: (1) supporting supervision and assessment of student nurses and (2) supporting interactions and partnerships between stakeholders.

CONCLUSION

The pedagogical design features of the digiQUALinPRAX resource provided nurse educators with valuable pedagogical knowledge in terms of supervision and assessment of student nurses, as well as simplified and supported interaction and partnership between stakeholders.

Opening My Eyes Building Nursing Student Awareness of Spirituality and Catholic Social Justice Principles

ABSTRACT

How can nursing academia impart concepts of spirituality, social justice, and personal and professional growth to nursing students? The authors of this qualitative study explored the narratives of 21 nursing students' reflective journals written while students were participating in a global clinical mission. A guided reflective journal grounded in Catholic social teachings and St. Francis' social justice principles was used daily during the mission to capture participants' thoughts and feelings. Data analysis revealed that students discovered principles of spirituality and social justice and expressed a deeper appreciation for being present for others, providing healthcare to all equally, and promoting the common good. Guided questions enhanced the experiential learning experience, fostering personal and professional growth.

Nurse educators' suggestions for a digital educational resource suitable for undergraduate student nurses' placement studies: Qualitative empirical research

AIMS

To explore and describe nurse educators' suggestions regarding a digital educational resource addressing quality in placement studies for first-year student nurses in nursing homes.

DESIGN

A qualitative, explorative, and descriptive research design.

METHODS

Focus group interviews with eight nurse educators and individual interviews with six nurse educators. The interviews were audio-recorded and transcribed verbatim; subsequently, data were analysed in lines with content analysis as described by Graneheim and Lundman.

RESULTS

The analysis revealed three main categories: 'Suggestions for a digital educational resource to strengthen and support nurse educators' role in follow-up students', 'Suggestions for a digital educational resource to complement and support interaction between stakeholders in placement', and 'Suggestions for a digital educational resource to facilitate student nurses' learning processes'. The categories were captured by the overarching theme, 'A digital educational resource facilitating interaction between stakeholders and students' learning processes.

CONCLUSION

This study revealed nurse educators' suggestions regarding design elements, content, and use of a digital educational resource addressing placement studies for first-year student nurses' in nursing homes. Implications for the profession and/or patient care: Nurse educators should be involved in designing, developing, and implementing digital educational resources aiming to support student learning in nursing education placement studies.

IMPACT

This study explored nurse educators' suggestions for a digital educational resource. They suggested a digital educational resource to strengthen and support their role, support interaction between stakeholders, and facilitate student nurses' learning processes. Further, they suggested a digital educational resource to be used as a supplement rather than as a replacement for nurse educators' physical presence in placements.

REPORTING METHOD

The Consolidated Criteria for Reporting Qualitative Research reporting guidelines were used. No Patient or Public Contribution.

Perspectives of Nursing Students on Promoting Reflection in the Clinical Setting: A Qualitative Study

Background: Reflection increases meta-cognitive capacities, promotes student-instructor relationships, overcomes the theory-practice gap, and enriches learning. This study aims at exploring nursing students’ perspectives on the facilitators of reflective practices in the clinical setting. Methods: Semi-structured interviews were conducted among 21 Saudi nursing students at one major university in Saudi Arabia. Results: Two major themes were prevalent upon thematic analysis, namely, “Personal Drivers of Reflection” which consisted of “Motivation to Learn”, “Desire to develop”, “Ethical Regard”, and “Responsibility towards patients” and “External Drivers of Reflection” which consisted of “Patient characteristics”, “Case complexity”, and “Competent Instructors”. Conclusion: As per the results of the study, nursing students perceived that they underwent reflection as a response to personal motivational and external educational aspects. According to the findings, instructors should assist students through clinical reflection, with a special focus on their interactions and motivation.

Saudi nursing student satisfaction and evaluation of reflective practice: A cross-sectional study

BACKGROUND

Regardless of the fact that reflection has been documented in nursing literature for several years and is recognized in the nursing profession to improve learners' knowledge and mindfulness, this topic requires investigation in Gulf countries from a student perspective, as no studies have been published in the gulf regarding nursing students' perspectives on reflective practice.

METHODS

A total of 261 nursing students from the third and fourth academic years at one major educational institution were recruited using a quantitative cross-sectional study design.

RESULTS

The participating nursing students reported high scores on the level of all domains of reflective practice as well as on the level of student satisfaction, where 3rd year students scored higher on the level of reflection with others (p = .03), as well as the reflection on action domains (p < .01). A significant correlation was found between reflection and satisfaction (p < .01), where reflection explained 6.87% of the changes in variance of satisfaction.

CONCLUSION

Nursing students who took part in this study has demonstrated a positive regard towards reflective practice and indicated high correlated satisfaction with learning.

Professional competence development through interprofessional simulation-based learning assists perioperative nurses in postgraduation acute clinical practice situations: A qualitative study

AIMS AND OBJECTIVES

To explore recently graduated perioperative nurses' experiences of interprofessional simulation-based learning during postgraduate education and investigate whether and how this learning approach contributed to the development of their professional competence in meeting acute clinical situations.

BACKGROUND

Perioperative nursing requires specialised education that offers professional development to ensure high-quality nursing care and patient safety in acute situations. Interprofessional simulation-based learning exposes students to acute situations in a safe environment without the risk of harming the patient, and it prepares postgraduate nursing students for clinical practice. Despite extensive research regarding simulation-based learning, there is a lack of knowledge on what impact such training has on perioperative nursing students after graduation.

DESIGN

An explorative qualitative design was used, and this study is reported in accordance with the COREQ guidelines.

METHOD

Between March 2019-November 2020, 16 perioperative nurses participated in semi-structured individual interviews three to five months after their graduation from five different educational institutions. During their postgraduate education, they had participated in interprofessional simulation-based learning that included acute clinical situations. A phenomenological hermeneutical analysis was applied to the data involving three steps: naïve reading, structural analysis and comprehensive understanding.

RESULTS

During the naïve reading, three themes emerged: competence in handling acute situations, competence in interprofessional teamwork and professional identity development.

CONCLUSION

Interprofessional simulation-based learning in perioperative nursing education developed relevant and important competence, including professional identity development, among perioperative nursing students. As recent graduates, their professional competence was transferred to clinical practice and developed further.

RELEVANCE TO CLINICAL PRACTICE

Findings indicate that interprofessional simulation-based learning is an important educational approach in perioperative nursing education. It is essential to use effective learning approaches to develop competencies that are transferable to clinical practice and improve perioperative nurses' performance as recent graduates. Therefore, interprofessional simulation-based learning should be implemented into perioperative nursing education.

Higher Education Students' Reflective Journal Writing and Lifelong Learning Skills: Insights From an Exploratory Sequential Study

Reflective journal (RJ) writing has been recognized as an effective pedagogical tool for nurturing students’ lifelong learning skills. With the paucity of empirical work on the dimensionality of reflective writing, this research sought to qualitatively analyze students’ RJ writing and design a generic reflection scheme for identifying dimensions of reflective thinking. Drawing on the theoretical scheme, another aim was to design and validate a questionnaire to measure students’ perceptions of their reflective writing experiences. The last aim was to quantitatively measure the link between perceived reflective writing and students’ tendency to use RJs in their future careers and personal lives. This exploratory sequential research included the following steps: First, experts’ review and analysis of 1312 RJ entries were attained. This step led to the design of a theoretical scheme of reflective writing and a 31-item questionnaire, used to gather data from 171 students (second-year pre-service teachers and third-year health managers). Partial Least Squares analysis corroborated the structure suggested by the theoretical scheme: two timelines–reflections regarding the current course assignments and those related to the student’s future development. Students’ tendency to use reflective skills in their future professional lives was highly connected to their long-term reflections, including learning experiences linked to academic, professional, personal, and multicultural development. The current study’s suggested validated generic scheme can be adapted and integrated into different curricula, thereby possibly increasing the potential of infusing RJ instructional strategies into higher education curricula, improving the quality of reflection in student journals, and promoting lifelong learning skills.