Factors impacting on nurses’ transference of theoretical knowledge of holistic care into clinical practice

A scoping review of therapeutic reasoning process research

Therapeutic reasoning is when the purpose, task, or goal for engaging in reasoning is to determine the patient's management plan. As the field's understanding of the process of therapeutic reasoning is less well understood, we focused on studies that collected data on the process of therapeutic reasoning. To synthesize previous studies of therapeutic reasoning characteristics, methodological approaches, theoretical underpinnings, and results. We conducted a scoping review with systematic searching for English language articles with no date limits. Databases included MEDLINE, CINAHL Plus, Scopus, Embase, Proquest Dissertations and Theses Global, and ERIC. Search terms captured therapeutic reasoning in health professions education research. Initial search yielded 5450 articles. The title and abstract screening yielded 180 articles. After full-text review, 87 studies were included in this review. Articles were excluded if they were outside health professions education, did not collect data on the process of therapeutic reasoning, were not empirical studies, or not focused on therapeutic reasoning. We analyzed the included articles according to scoping questions using qualitative content analysis. 87 articles dated from 1987 to 2019 were included. Several study designs were employed including think-aloud protocol, interview and written documentation. More than half of the articles analyzed the data using qualitative coding. Authors often utilized several middle-range theories to explain therapeutic reasoning processes. The hypothetico-deductive model was most frequently mentioned. The included articles rarely built off the results from previous studies. Six key result categories were found: identifying themes, characterizing and testing previous local theory, exploring factors, developing new local theory, testing tools, and testing hypothesis. Despite the cast body of therapeutic reasoning research, individual study results remain isolated from previous studies. Our future recommendations include synthesizing pre-existing models, developing novel methodologies, and investigating other aspects of therapeutic reasoning.

Nursing experiences in antimicrobial optimisation in the intensive care unit: A convergent analysis of a national survey

BACKGROUND

Recent evidence highlights the need for an interdisciplinary approach to antimicrobial stewardship (AMS). Nursing involvement in optimising antimicrobials in the intensive care unit (ICU) remains understudied.

OBJECTIVE

The objective of this study was to explore nurses' perceptions and experiences of antimicrobial optimisation or stewardship in ICUs in Australia.

METHODS

An anonymous web-based survey was deployed nationally in early 2021 through two ICU nursing networks. Associations between survey responses were analysed descriptively and by using nonparametric tests (with statistical significance established at p ≤ 0.05). Free-text survey responses underwent qualitative thematic analysis. Interpretation and reporting of quantitative and qualitative data were integrated.

RESULTS

A total of 226 ICU nurses completed the survey. The majority (197/226; 87%) responded that lack of education limits engagement in AMS. Only 13% (30/226) reported the presence of AMS education and training for nurses in their ICUs. Only about half (108/226; 48%) of the nurses were confident to question prescribers when they considered that the antimicrobial prescribed was unnecessary, with nurses in senior roles more likely to do so than nurses providing bedside care (p < 0.05). Gaps in education (including unfamiliarity with AMS roles), noninclusive antimicrobial discussions, moral distress, and potential workload burden were seen as potential barriers/challenges to engagement.

CONCLUSION

The multifactorial barriers identified that inhibit nurses from performing AMS tasks could be addressed by strengthening interprofessional education at all levels and by applying practical AMS interventions that are inclusive for nursing participation. A purposeful culture change that fosters psychological safety and collaborative practice is paramount to supporting nurses in these roles.

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

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

Development and psychometric evaluation of an emotional growth questionnaire for university students

Background: Despite the importance of emotional growth promotion among students, there is still a lack of standard emotional growth tools to evaluate the concept while developing interventional programs. The aim of present study was to devise and provide a valid and reliable instrument for measuring students' emotional growth. Methods: This study was conducted from 2016 to 2017 among university students. A questionnaire containing 79 items was made using focus group discussions with students and studying relevant texts. Exploratory factor analysis (EFA) (n = 188) was used to determine the construct validity of the questionnaire. Confirmatory factor analysis (CFA) (n = 38) was performed to assess the validity of the model. Reliability (n = 56) and repeatability (n = 31) of the questionnaire were assessed. Results: A 4-factor (positive identity, self-esteem, effective communication and motivation)and 21-item solution was found as the best solution, which explained 63.5% of total variancebetween the items. The results of CFA approved the validity of the model (CFI = 0.914, RMSEA= 0.070). Cronbach alpha (0.93) and Intra class correlation coefficient (0.91) approved the reliability and repeatability of questionnaire. Conclusion: The 21 items questionnaire seems to be a valid and reliable instrument to measure emotional growth among university students.

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.

Challenges in the clinical education of the nursing profession in Iran: A qualitative study

INTRODUCTION

Clinical education is an important part of nurse training. It provides students with the opportunity to gain useful experience and has a key role in their professional preparation. The importance of clinical education in nursing students' professional performance means that identifying the challenges in this field is crucial.

AIM

The goal of this study is to identify challenges in the field of clinical nurse education.

DESIGN

A qualitative content analysis study.

SETTING

A faculty of Nursing and Midwifery, in Iran 2017.

PARTICIPANTS

Nine student nurses, three qualified nurses and two nursing educators.

METHODS

This study has been applied to various depths of interpretation. Semi-structured interviews were used to collect the data. Nine student nurses, three qualified nurses and two nursing educators were interviewed.

RESULTS

The analysis of the interviews generated five categories. Two main themes were extracted as challenges in the clinical training of nursing professionals: 1. Inefficient educational structure and 2. Inefficient professional performance environment.

CONCLUSION

Considering the inadequate professional performance environment and defective educational structure, designing and delivering lessons with clear goals is essential. Using objective and measurable scales for evaluating educational standards, the use of empowered instructors with high communicational skills is useful for increasing students' motivation and interest toward clinical education and solving existing challenges.

The impact of 'missed care' on the professional socialisation of nursing students: A qualitative research study

BACKGROUND

Missed care is a recently described concept that is subject to an increasing amount of international nursing research. The impact of missed care is associated with poorer patient outcomes (mortality and morbidity) and poorer levels of patient satisfaction with the services provided by the hospital. Missed care has also been linked to decreased staff satisfaction and increased intention to leave. Overall disaffection amongst registered nurses has also been reported. Professional socialisation refers to the acquisition of behaviours within cultural norms, and it has been suggested that students enter a period of professional socialisation during their programme. Whilst it has been proposed that students may absorb the characteristics of those around them, to date, no empirical studies have reported the impact of missed care on student nurses.

METHODS

The aim of this project is to explore the impact of missed care on the professional socialisation of student nurses. A qualitative study was undertaken in one higher education institute in UK with final year pre-registration nursing degree (adult field) students. Focus group interviews, utilizing a broad topic guide, were used to collect data which was analysed using thematic analysis.

FINDINGS

Student nurses were aware that some planned care is missed and these findings resonated with those identified in the literature. In addition to illuminating aspects of professional socialisation, analysis yielded five themes with regards to missed care: awareness, rationale, impact, strategies to avoid and influence of missed care on career aspiration. Student nurses exposed to missed care appear to accept this as part of their professional socialisation.

CONCLUSION

With regards to professional socialisation, student nurses developed a pragmatic acceptance that care would be missed and that this could happen in any environment. As such they did not see missed care as influencing their career aspirations.

Effectiveness of the I2AO2 interdisciplinary programme led by nurses on metabolic syndrome and cardiovascular risk: a randomized, controlled trial

Objective To evaluate the effectiveness of an interdisciplinary programme led by nurses in relation to metabolic syndrome (MS) and cardiovascular risk (CVR). Methods This randomized, controlled, clinical trial included 74 patients diagnosed with MS (experimental group [EG], n = 37; control group [CG], n = 37). The intervention consisted of a 12-month interdisciplinary programme (pre-test, 6 months of intervention, 12 months of intervention, and 1-year follow-up post-intervention) coordinated by nursing. Results We found a progressive and significant reduction for all clinical, biochemical, and anthropometric parameters analysed at different time points. In the EG, remission of MS by 48.1% in the short term was observed (83.8% in the medium term) and maintained at 1 year post-intervention. In the CG, the prevalence of MS increased by 2.7% from the initial evaluation to study completion. A similar trend was observed for CVR. In the EG, 100% of subjects had a moderate-low risk of CVR at 1 year post-intervention, whereas the CG had CVR in all categories. Conclusion An interdisciplinary, nurse-led programme improves participants' metabolic and cardiovascular health, while maintaining long-term effects. Our findings suggest an important role of the professional nurse as a nexus between the patient, different professionals, and the community.

Factors affecting conscience-based nursing practices: A qualitative study

BACKGROUND

Conscience is a guiding factor in nursing practice for delivering the ultimate care. In order to expand the concept of conscience-based care, factors affecting conscience in nursing practice need to be identified.

OBJECTIVES

The current study assessed nurses' experiences to explore factors affecting conscience in nursing practice.

RESEARCH DESIGN

This qualitative content analysis study employed purposive sampling to reach 14 nurses working at educational hospitals in Tabriz and Urmia, Iran. Data were analyzed using inductive and conventional analysis.

ETHICAL CONSIDERATIONS

This research was approved by the Ethics Committee of Urmia University of Medical Science. Voluntary participation, anonymity, and confidentiality were considered.

FINDING

Two themes emerged from our analysis for enhancing conscience in nursing practices, including environment of professional performance and personal factors.

DISCUSSION

The two important factors for enhancing conscience in nursing practice are environment and personal factors.

CONCLUSION

It is necessary to emphasize on religious beliefs, professional commitment, and communication skills in educational training structure. Also, establishing appropriate management systems will help nurses to provide moral care.

Translating Knowledge From a Family Systems Approach to Clinical Practice: Insights From Knowledge Translation Research Experiences

While there has been continued growth in family nursing knowledge, the complex process of implementing and sustaining family nursing in health care settings continues to be a challenge for family nursing researchers and clinicians alike. Developing knowledge and skills about how to translate family nursing theory to practice settings is a global priority to make family nursing more visible. There is a critical need for more research methods and research evidence about how to best move family nursing knowledge into action. Enhancing health care practice is a multifactorial process that calls for a systemic perspective to ensure its efficacy and sustainability. This article presents insights derived from lessons learned through recent research experiences of using a knowledge translation model to promote practice changes in health care settings. These insights aim to optimize (a) knowledge translation of a Family Systems Approach (FSA) in practice settings; (b) knowledge translation research processes; and

Exploring Nurses' Meaning and Experiences of Compassion: An International Online Survey Involving 15 Countries

PURPOSE

In recent years, there has been much focus on compassion in nursing care, and concern has been raised in a number of reports and media stories regarding decreased compassion. The aim of this study was to explore similarities and differences in the understanding and demonstration of compassion in nursing practice across 15 countries.

DESIGN

A total of 1,323 nurses from 15 countries responded to questions in relation to compassion, via an international online survey.

RESULTS

The data revealed the impact of sociopolitical influences on perceptions of compassion, and the conscious and intentional nature of compassion.

DISCUSSION AND CONCLUSION

The study demonstrated shared understandings of the importance of compassion as well as some common perceptions of the attributes of compassionate care. The differences reported were not as significant as had been expected.

IMPLICATIONS FOR PRACTICE

Further research is needed to explore the country and culture differences in the enactment of compassion.

A Concept Analysis of Holistic Care by Hybrid Model

Purpose:

Even though holistic care has been widely discussed in the health care and professional nursing literature, there is no comprehensive definition of it. Therefore, the aim of this article is to present a concept analysis of holistic care which was developed using the hybrid model.

Methods:

The hybrid model comprises three phases. In the theoretical phase, characteristics of holistic care were identified through a review of the literature from CINAHL, MEDLINE, PubMed, OVID, and Google Scholar databases. During the fieldwork phase, in-depth interviews were conducted with eight nurses who were purposely selected. Finally, following an analysis of the literature and the qualitative interviews, a theoretical description of the concept of holistic care was extracted.

Results:

Two main themes were extracted of analytical phase: “Holistic care for offering a comprehensive model for caring” and “holistic care for improving patients' and nurses' conditions.”

Conclusion:

By undertaking a conceptual analysis of holistic care, its meaning can be clarified which will encourage nursing educators to include holistic care in nursing syllabi, and consequently facilitate its provision in practice.

An exploration of role model influence on adult nursing students' professional development: A phenomenological research study

Patients' expectations of being cared for by a nurse who is caring, competent, and professional are particularly pertinent in current health and social care practice. The current drive for NHS values-based recruitment serves to strengthen this. How nursing students' development of professionalism is shaped is not fully known, though it is acknowledged that their practice experience strongly shapes behaviour. This study (in 2013-14) explored twelve adult nursing students' lived experiences of role modelling through an interpretive phenomenological analysis approach, aiming to understand the impact on their development as professional practitioners. Clinical nurses influenced student development consistently. Some students reported that their experiences allowed them to learn how not to behave in practice; a productive learning experience despite content. Students also felt senior staff influence on their development to be strong, citing 'leading by example.' The impact of patients on student professional development was also a key finding. Through analysing information gained, identifying and educating practice-based mentors who are ready, willing, and able to role model professional attributes appear crucial to developing professionalism in nursing students. Those involved in nurse education, whether service providers or universities, may wish to acknowledge the influence of clinical nurse behaviour observed by students both independent of and in direct relation to care delivery and the impact on student nurse professional development. A corollary relates to how students should be guided and briefed/debriefed to work with a staff to ensure their exposure to a variety of practice behaviours.

Integrating the Illness Beliefs Model in clinical practice: a Family Systems Nursing knowledge utilization model

To promote the integration of Family Systems Nursing (FSN) in clinical practice, we need to better understand how nurses overcome the challenges of FSN knowledge utilization. A qualitative exploratory study was conducted with 32 practicing female nurses from hospital and community settings who had received FSN intervention training and skill development based on the Illness Beliefs Model and the Calgary Family Assessment and Intervention Models. The participants were interviewed about how they utilized FSN knowledge in their nursing practice. From the data analysis, a FSN Knowledge Utilization Model emerged that involves three major components: (a) nurses' beliefs in FSN and in their FSN skills, (b) nurses' knowledge utilization strategies to address the challenges of FSN practice, and (c) FSN positive outcomes. The FSN Knowledge Utilization Model describes a circular, incremental, and iterative process used by nurses to integrate FSN in daily nursing practice. Findings point to a need for re-evaluation of educational and management strategies in clinical settings for advancing the practice of FSN.

Effective factors in providing holistic care: a qualitative study

BACKGROUND

Holistic care is a comprehensive model of caring. Previous studies have shown that most nurses do not apply this method. Examining the effective factors in nurses' provision of holistic care can help with enhancing it. Studying these factors from the point of view of nurses will generate real and meaningful concepts and can help to extend this method of caring.

MATERIALS AND METHODS

A qualitative study was used to identify effective factors in holistic care provision. Data gathered by interviewing 14 nurses from university hospitals in Iran were analyzed with a conventional qualitative content analysis method and by using MAXQDA (professional software for qualitative and mixed methods data analysis) software.

RESULTS

Analysis of data revealed three main themes as effective factors in providing holistic care: The structure of educational system, professional environment, and personality traits.

CONCLUSION

Establishing appropriate educational, management systems, and promoting religiousness and encouragement will induce nurses to provide holistic care and ultimately improve the quality of their caring.

A systematic review of clinical assessment for undergraduate nursing students

BACKGROUND

Consolidated clinical practicum prepares pre-registration nursing students to function as beginning practitioners. The clinical competencies of final-year nursing students provide a key indication of professional standards of practice and patient safety. Thus, clinical assessment of nursing students is a crucial issue for educators and administrators.

OBJECTIVE

The aim of this systematic review was to explore the clinical competency assessment for undergraduate nursing students.

DATA SOURCES

PubMed, CINAHL, ScienceDirect, Web of Science, and EBSCO were systematically searched from January 2000 to December 2013.

METHODS

The systematic review was in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Published quantitative and qualitative studies that examined clinical assessment practices and tools used in clinical nursing education were retrieved. Quality assessment, data extraction, and analysis were completed on all included studies.

RESULTS

This review screened 2073 titles, abstracts and full-text records, resulting in 33 included studies. Two reviewers assessed the quality of the included studies. Fourteen quantitative and qualitative studies were identified for this evaluation. The evidence was ordered into emergent themes; the overarching themes were current practices in clinical assessment, issues of learning and assessment, development of assessment tools, and reliability and validity of assessment tools.

CONCLUSION

There is a need to develop a holistic clinical assessment tool with reasonable level of validity and reliability. Clinical assessment is a robust activity and requires collaboration between clinical partners and academia to enhance the clinical experiences of students, the professional development of preceptors, and the clinical credibility of academics.

Contextual barriers to the successful implementation of family-centered practice in mental health care: a Hong Kong study

This article presents findings from an exploratory study to identify nurses' perspectives on factors that hinder the implementation of family-centered practice in mental health settings in Hong Kong. Thirty-four nurses participated in the study by completing the pre- and post-questionnaires. Ten nurses were invited to participate in focus group and case interviews. The analysis identified knowledge-practice gap, role of psychiatric nurses, professional identity of psychiatric nurses, and management support as negatively affecting the nurses in implementing a family-centered approach to mental health care. Suggestions about facilitating the implementation of the family-centered approach into clinical practice are offered.

Beyond nursing nihilism, a Nietzschean transvaluation of neoliberal values

Like most goods-producing sectors in the West, modern health-care systems have been profoundly changed by globalization and the neoliberal policies that attend it. Since the 1970s, the role of the welfare state has been considerably reduced; funding and management of health systems have been subjected to wave upon wave of reorganization and assimilated to the private sector. At the same time, neoliberal policy has imposed the notion of patient empowerment, thus turning patients into consumers of health. The literature on nursing has accordingly reported on the significant repercussions on all aspects of the profession, from delivery of care and treatment, through training for new nurses, to legislated policy reforms regarding the role and responsibilities of modern nurses. In light of these developments, this paper analyses and theorizes about the way the injection of neoliberal policy is linked to and affects the practice of nursing. Drawing on a number of Nietzschean arguments, we begin with an exploration of the complex effects of neoliberalism, bureaucratization, and technocratization on the health system and the practice of nursing. Our main theoretical point here is that neoliberal policy engenders and promotes a neoliberal tide, which results in the conversion of the values that drive modern nursing practice. We then examine this tide in the light of Nietzsche's concepts. Starting with an analysis based on the ontology of the will to power, we show that nurses are dominated by neoliberal values embedded in technocratic and bureaucratic ideologies. Finally, we argue that the application of neoliberal policy constitutes a form of domestication from which one might potentially be freed through the Nietzschean concept of transvaluation of values. This transvaluation, as its freeing from some of the neoliberal tide, may be accomplished in accordance with a hierarchy of specific life-affirming values for nursing culture and practice.

Novice nurses' experiences of unpreparedness at the beginning of the work

Introduction:

Unpreparedness of novice nurses during the process of transition to their professional role can has broad consequences for the nurse and health care system and leads to reduction of the quality of patient care. This study has been carried out with the aim of investigating the experiences of the unpreparedness of novice nurses.

Method:

This study was conducted qualitatively by using conventional content analysis. Participants were 21persons including 17 novice nurses, 2 supervisors, and 2 experienced nurses who were selected through purposeful sampling from four hospitals dependent on Tehran University of Medical Sciences.

Findings:

Participants' experiences were reflected in three main themes of "functional disability", "communicative problems", and "managerial challenges". Each of these dimensions consisted of several sub-categories. These areas had represented the inability to apply the learned knowledge in practice.

Discussion:

The sensitivity of health system, especially, educational mentors and nursing managers to create preparation in novice nurses by providing appropriate orientation programs at the beginning of work and the revision and amendment of nursing curriculum can solve this problem to some extent.

Nursing students' perceptions of clinical supervision: the contributions of preceptors, head preceptors and clinical lecturers

AIM

The aims of the study were 1) to investigate to what extent nursing students were satisfied with the supervision provided by facilitators (preceptor, head preceptor, and clinical lecturer), 2) to compare nursing students' ratings of facilitators' contribution to supervision as supportive and challenging, and 3) to examine relationships between facilitators' supportive and challenging behavior in supervision and nursing students' perception of fulfillment of expected learning outcomes in clinical education.

BACKGROUND

Although there are many studies on support of students in clinical education, few have addressed this from the students' point of view or made comparisons between different facilitators.

METHODS

A cross-sectional survey study was conducted during April to November 2010, where 107 nursing students, from a university in central Sweden, answered a questionnaire about supervision immediately after their period of clinical education.

RESULTS

Supportive behavior in supervision was rated higher by students for all facilitator groups as compared with challenging behavior. The students rated preceptors and clinical lecturers as more supportive than head preceptors and clinical lecturers as providing more challenges than the two other facilitator groups. Supportive and challenging behavior in supervision explained 39% of the variance in students' overall learning outcomes. However, the regression coefficient was only significant for students' ratings of supportive behavior for the preceptor.

CONCLUSIONS

Nursing students were satisfied with facilitators' supervision and by their contribution to fulfillment of overall learning outcomes. Comparisons showed that preceptors in a higher degree were perceived as supportive while clinical lecturers were perceived as more important as challengers for critical thinking, reflection and exchange of experiences between students. The model of supervision seems to be promising, but the roles across facilitators need to be made clearer, especially the head preceptor's role, which seemed to be the most unclear role in this model.

Evaluation of the case method in nursing education

The case based learning (CBL) is a problem-based learning which engaging students and presenting them with learning-related and cognitive challenges. The purpose of the study was to elucidate nursing students experiences of the CBL as an educational tool in order to find out if it supports their learning. Qualitative content analysis was used and performed on the statements from nursing students' course evaluations. Students perceived the CBL as an approach combining theory with practice which provides an overview of upcoming profession. Students gain adequate knowledge about patient care in reality and thereby enabling them to obtain a holistic understanding of patients health problems. Reflections related to case seminars widen students perspectives, improve their capacity for cooperation and help them to achieve long-lasting knowledge. This learning method offers nursing students an opportunity to enhance their judgement and critical thinking skills by applying theory in practice. Students gain adequate knowledge about patient care which may benefit patient care due to students acting professionally in their future role.

A Different Drum

The authors in this article describe the background and development of a drama-based educational initiative for student nurses in the United Kingdom (UK) Forty-five student nurses from Adult and Mental-Health fields of study took part in a one-day experience where they worked alongside individuals with learning disabilities to produce art, dance, and drama sketches. The workshop was evaluated using a validated questionnaire to explore the experience from the students’ perspectives. Students felt challenged as they were pushed beyond the comfort zone of a regular classroom environment. Moreover, a greater understanding of core concepts such as empathy, dignity, stigma, and social exclusion were identified as key outcomes of the experience. The focus for future work in this field is to explore the ways in which arts-based learning and teaching initiatives can be developed within mainstream curricula.

The use of case studies as a learning method during pre-registration critical care placements

Critical care nursing is no longer confined to intensive care units. It is now recognised that patients outside intensive care require critical care nursing. () Pre-registration nursing students must be prepared both clinically and theoretically to provide holistic care for critically ill patients and their families. This project examines how the development of case studies by one cohort of pre-registration students during their critical care placements supported their learning, and encouraged a holistic approach to patient care. Students developed case studies based on actual patients they cared for. The students critically analysed the care they provided and grounded their assignment and practice in recent research findings. To evaluate the effectiveness of this method of learning, nominal group technique and questionnaires were employed to gather data from the students. Analysis of both quantitative and qualitative data illustrated that the use of case studies as part of the academic assignment encouraged students to develop a holistic approach in caring for the critically ill patient and family. Students also agreed that they incorporated previous theoretical and clinical experience into the care of the patients. It is recommended that this learning method could be used and evaluated within assignments associated with other clinical placements both at pre-registration and post registration levels.

The infection control education needs of nursing students: an interview study with students and mentors

AIM

To identify and explore the infection prevention and control education needs of nursing students as perceived by students and mentors.

METHODS

Semi-structured interviews were undertaken with 31 nursing students within one large university and 32 nurse mentors in one large NHS Trust. Interview transcripts were analysed using framework analysis.

RESULTS

There were perceived deficits in both levels of knowledge and clinical skills but the emphasis placed on these differed between nursing students and nurse mentors. The use of small group and interactive methods for teaching and learning was preferred, in particular to encourage less confident students to participate more. Assessments in practice placements of specific skills were identified as a good teaching and learning tool by both students and mentors. Infection prevention and control education was considered to be a joint responsibility between the university and Trust, though there was acknowledgement that this joint working was not always evident. Clinical credibility was considered particularly important by mentors in those who teach students.

CONCLUSION

There may be deficits in the education provided to nursing students in this area. Teaching and learning preferences and strategies for improving some areas of teaching and learning have been identified and several areas for future research have been suggested.

"This is nursing": nursing roles as mediated by precepting nurses during clinical practice

In nursing education, it has been argued that professional socialization is facilitated by clinical experiences where students work together with precepting nurses. However, few studies found have focused on how nurses think and act as preceptors, hence providing a base for professional socialization to occur. Therefore; this study aimed to describe how preceptors mediated nursing as a profession to undergraduate nursing students during clinical practice. This was an ethnographic study guided by symbolic interactionism. A purposeful sampling of 13 precepting nurses was observed during the field work period. In addition, 16 staff nurses, purposively selected, and experienced in precepting, participated in focus group interviews. All text from field notes and interviews were read as a whole and analyzed following the ethnographic approach. Findings illustrated how nursing was mediated as the medical-technical, the administrative, and the caring role. Preceptors aimed for professionalism in their students by teaching the students to reflect on what they can do independently as nurses. Preceptors strived to verbalise their practical knowledge to make theory explicit and contextualize to student nurses. This knowledge can guide implementation of preceptor programmes focusing on the meaning and implications of professionalism.

Implementing family nursing: how do we translate knowledge into clinical practice? Part II: The evolution of 20 years of teaching, research, and practice to a Center of Excellence in Family Nursing

The author's reflections on knowledge transfer/translation highlight the importance of the circular process between science and practice knowledge, leading to the notion of "knowledge exchange." She addresses the dilemmas of translating knowledge into clinical practice by describing her academic contributions to knowledge exchange within Family Systems Nursing (FSN). Teaching and research strategies are offered that address the circularity between science and practice knowledge. The evolution of 20 years of teaching, research, and clinical experience has resulted in the recent creation of a Center of Excellence in Family Nursing at the University of Montreal. The three main objectives of the Center uniquely focus on knowledge exchange by providing (a) a training context for skill development for nurses specializing in FSN, (b) a research milieu for knowledge "creation" and knowledge "in action" studies to further advance the practice of FSN, and (c) a family healing setting to support families who experience difficulty coping with health issues.

Nursing Students' Perceptions of a Holistic Nursing Conference

Purpose: The purpose of the study was to describe nursing students' perceptions of their experiences at the 2007 annual conference of the American Holistic Nurses Association (AHNA), and identify benefits of professional conference attendance as an educational strategy for undergraduate nursing students. Method: Sixteen nursing students attended the 2007 AHNA annual conference and made daily journal entries about their perceptions of the conference. Using a descriptive qualitative approach, researchers analyzed their journal entries for recurring themes. Findings: Themes suggested that nursing students gained knowledge about holistic nursing and felt empowered through personal interactions with national holistic nursing leaders. They felt motivated to incorporate holistic nursing principles into practice and self-care. In addition, they expressed an appreciation for the importance of lifelong learning and maintaining clinical competency through attendance at a professional conference. Implications for Education: Nursing students' attendance at a holistic nursing professional conference is a useful educational strategy that has many benefits.

Nurses' attitudes about the importance of families in nursing care: a survey of Swedish nurses

The purpose of this study was to investigate the attitudes of registered nurses (RNs) about the importance of involving families in nursing care. A sample of 634 randomly selected Swedish RNs completed the instrument, Families' Importance in Nursing Care-Nurses' Attitudes (FINC-NA), and reported holding supportive attitudes about families. High scores were found for the subscales: family as a resource in nursing care, family as a conversational partner, family as a burden, and family as its own resource. Variables that predicted a less supportive attitude about involving families in nursing care included being a newly graduated nurse, having no general approach to the care of families at the place of work, and being a male nurse.

'New professionalism'-shifting relationships between nursing education and nursing practice

New professionalism values egalitarian professional-client partnerships and considers competence integral. Within nursing competence has been accepted as the legitimate indicator of professional practice. There is a growing emphasis on instrumental competence and this has been accompanied by some erosion of relational care. In this paper I argue that new professionalism is problematic and nursing education faces particular challenges. These include negotiating service-education partnerships which reflect service user involvement and enable the integration of wider notions of competence.

User perceptions of the knowledge underpinning practice orientation dial (KUPOD) as a tool to enhance learning

The concern of academics and clinicians about the alleged dichotomy between theoretical concepts and the practice of nursing has been the catalyst for the development of a pocket-sized aid for nurses, known as the Knowledge Underpinning Practice Orientation Dial (KUPOD [N]/The Dial). A mixed method approach was used incorporating a questionnaire and a focus group of educators. The Dial was introduced, as part of a module, undertaken by a cohort of second-year Diploma in Nursing (Adult Branch) students. Twenty-eight students returned the questionnaire (response rate=85%). Results revealed that the Dial was easy to use in a variety of situations and locations. Respondents used the Dial within clinical and classroom settings and for self directed study. They reported that it was a practical and effective aid to learning, assisting in correlating theory and practice. It supported reflection and enhanced confidence in the clinical area, indicating that this economically produced tool helps to bridge the theory-practice gap. The Dial is now being introduced as a learning resource to a wider range of students.

Iranian nurses' perceptions of theoretical knowledge transfer into clinical practice: A grounded theory approach

Since nursing education was transferred to universities in Iran, the public and health administrators have criticized Iranian nurses because of poor-quality patient care. It seems that nurses are not able to transfer the taught theoretical knowledge in academia into practice. This paper attempts to provide an insider view of why the taught theoretical knowledge in academia might be difficult to enact in the clinical setting. Using the grounded theory approach, individual in-depth interviews and participant observation were undertaken with a purposive and theoretical sample of 26 participants in Tehran University of Medical Sciences. The data were analyzed using the constant comparative method. The findings showed that, in spite of increased academic input into nursing education, clinical behaviors in both the education and practice settings were perceived as "traditional routine-based".

The clinical role of nurse lecturers: Past, present, and future

The clinical role of nurse lecturers has been the subject of much debate since the transfer of nurse education into Higher Education Institutions within the United Kingdom. This article provides a critical evaluation of the clinical role of nurse lecturers in terms of policy drivers and strategies for implementing national guidelines. Policies from the initiation of Project 2000, through to recent consultation documents on the support of students in practice, are evaluated. Formal aspects of the nurse lecturer remit, such as link tutor and personal supervisor roles, are discussed in terms of their impact on clinical practice. There is also a brief review of the development of the lecturer practitioner role as a bridge between education and practice. The fundamental arguments in support of nurse lecturers maintaining a clinical role in practice are analysed. This analysis includes consideration of the concept of 'clinical credibility' in terms of the impact on teaching and the closure of the theory-practice gap. The article concludes with suggestions for strategies to resolve the ongoing debate surrounding the clinical role of nurse lecturers. These recommendations include a review of staff:student ratios in nurse education, re-evaluation of the need for a clinical role, and the use of innovative recruitment and development strategies by higher education institutions.

The sustainability of ideals, values and the nursing mandate: evidence from a longitudinal qualitative study

This article reports on research that examines newly qualified UK nurses' experiences of implementing their ideals and values in contemporary nursing practice. Findings are presented from questionnaire and interview data from a longitudinal interpretive study of nurses' trajectories over time. On qualification nurses emerged with a coherent and strong set of espoused ideals around delivering high quality, patient-centred, holistic and evidence-based care. These were consistent with the current UK nursing mandate and had been transmitted and reinforced throughout their 'prequalification' programmes. The existence of professional and organisational constraints influenced their ability to implement these ideals and values once in practice. Data analysis revealed that within 2 years in practice the newly qualified nurses could be categorised as sustained idealists, compromised idealists, or crushed idealists. The majority experienced frustration and some level of 'burnout' as a consequence of their ideals and values being thwarted. This led to disillusionment, 'job-hopping' and, in some cases, a decision to leave the profession. These data are explored and discussed to inform the question of whether the current nursing mandate is sustainable.

The theory-practice gap: impact of professional-bureaucratic work conflict on newly-qualified nurses

AIM

This paper reports the findings from a naturalistic enquiry undertaken in the United Kingdom into the extent to which the ideals and values of the preregistration nursing course are adopted by individual newly educated Registered Nurses.

BACKGROUND

Research in several countries provides consistent evidence of the existence of a theory-practice gap in nursing. Clear disparities have been demonstrated between the best practice ideals and values that are taught and those actually encountered in everyday practice. Nurse education 'Project 2000' reforms in the United Kingdom were designed, in part, to address this issue. Few studies to date have examined the impact of these reforms on newly qualified Registered Nurses' ability to translate theory into practice.

METHODS

A longitudinal study was carried out in three educational institutions in the United Kingdom from 1997 to 2000. Final year nursing students (n = 72) in three colleges of nursing completed questionnaires to elicit views on their ideals and values for practice. In-depth interviews with a purposive subsample of 26 participants (at 4-6 and 11-15 months postqualification) indicated the extent to which these ideals and values were adopted in practice. Interviews were tape-recorded, transcribed, and data were analysed using constant comparison and negative case analysis.

FINDINGS

Although new nurses emerged from their programmes with a strong set of nursing values, a number of professional and organizational factors effectively sabotaged implementation. Professional sabotage includes obeying covert rules, lack of support and poor nursing role models. Organizational sabotage includes structural and organizational constraints such as time pressures, role constraints, staff shortages and work overload.

CONCLUSION

The disparity between nursing as taught and as practised may have profound implications for the future of the profession both in the United Kingdom and internationally, in terms of morale, job satisfaction and retention. Measures to improve resources and reduce the professional-bureaucratic work conflict are discussed.

Challenges for new nurses in evidence-based practice

AIM

The purpose of this article was to examine issues that new nurses encounter as they enter nursing practice, particularly in an evidence-based practice environment.

BACKGROUND

These issues are not new. In part, these issues arise from our failure to acknowledge the developmental issues that new nurses experience on entry to practice and the lack of role models in evidence-based practice and holistic care.

EVALUATION

This article synthesizes research reported over the last decade to delineate the issues of transition to practice and strategies that have proven effective in addressing them.

KEY ISSUES

The key issues relate to the need to support new nurses in evidence-based and holistic practice, the strategies needed to do so, and the nurse manager's role in this process.

CONCLUSIONS

We must invest resources in assisting new nurses into practice, which may have benefits in terms of both recruitment and retention of new nurses in practice.

Is the humanistic view of the nurse role still alive--in spite of an academic education?

AIM

This paper is a report of a study exploring what 'being a good nurse' means by following nursing students during their pre-registration education and for some years after graduation.

BACKGROUND

There have been few studies focusing on the nurse role in the transition from student to experienced nurse. Studies with a qualitative design, in particular, are limited in number.

METHODS

A longitudinal survey design was adopted, using an open-ended questionnaire at the beginning of education (n = 164), just before graduation (n = 123), and 3-5 years after graduation (n = 77). The participants were students in the nursing programme at a Swedish university. The data were collected during the period 1993-2002. Latent and manifest content analyses were used.

FINDINGS

Four categories were identified in the data. 'To do good for others', with the sub-category 'to care for others', was most frequent over time and quite stable. The category 'to be competent and skilled' was frequent and increased over time. 'To have professional courage and pride' and 'to seek professional development' were mentioned to lesser extent and showed a slight increase over time. The meaning of being a good nurse grew in complexity over time and informants' professional awareness seemed to increase, especially concerning 'to be competent and skilled'.

CONCLUSION

Attention needs to be paid both to nursing education and practice. Clinical supervision given by nurses with Master's degrees is suggested in order to convey positive attitudes towards nursing development and research into practice. Further studies are needed to compare what 'a good nurse' means to graduate nurses and how they actually behave when performing good nursing care.

Helping student nurses to identify and respond to the psychological needs of physically ill patients: implications for curriculum design

It is universally accepted that nursing practice is predicated upon the notion of holistic care, in that nurses need to address not only the physical needs of ill patients but also their psychological, social, spiritual, and environmental needs. However, there is considerable evidence to suggest that nurses often inadequately identify and respond to patients' psychological needs, sometimes with adverse consequences for physical health and recovery. This may be because they do not fully understand the concept of psychological care, or have been inadequately prepared or educated to deliver it in practice. Following a summary of relevant literature and an overview of findings from a larger study of the nature and experience of psychological caregiving, this paper discusses specific findings on preparing nurses for their psychological caregiving role. The paper proposes a curriculum framework designed to enhance awareness, knowledge, and skill in effective psychological caregiving in nursing practice, to the ultimate benefit of physically ill patients. For the purposes of this paper, psychological care is taken to mean one element of the broader concept of care, rather than being synonymous with it.