A comparative study of stress between pre‐ and post‐Project 2000 students

Nursing Student's Experiences of Meditation on Twin Hearts During Eight Weeks Practice: A Qualitative Content Analysis

Background

Meditation on Twin Hearts (MTH) involves blessing the earth to alleviate the sufferings, and praying for the well-being of the entire society using heart and crown chakra. This meditation is characterized by mechanisms of loving-kindness, self-healing imagery, and open awareness.

Purpose

This study aims to identify the experiences and perceived benefits associated with practicing MTH by nursing students.

Method

Qualitative method using content analysis was used to study meditation experiences. After obtaining the informed consent, 22 nursing students were introduced to MTH. Experiences and feedback from meditation sessions were reported each day during their 8 week practice. Nursing students also answered seven open-ended questions on the last day of the meditation session.

Findings

The verbatim descriptions of experiences reported by nursing students were abstracted to elements (17), properties (6), and categories (2). Identified properties are positive experiences, experiences of awareness, energy experiences, tangible outcomes, physiological reactions, and feedback on the study program.

Conclusion

The experiences narrated by nursing students include positive affective experiences, health benefits, resolution of problem, awareness and energy experiences, and prosocial tendencies. These findings indicate that MTH would enhance the well-being of the nursing students and could be used as a self-care measure.

Non-greeting rituals in clinical placements

BACKGROUND

This study aims to generate knowledge about how clinical placements contribute to the creation of sustainable nursing education in Denmark. The article discusses how nursing students feel socially excluded when registered nurses do not recognise them through deviating from culturally appropriate greeting rituals.

METHOD

A constructivist grounded theory study of (n = 15) individual semi-structured interviews with nursing students in their first and third years of study.

RESULTS

Nursing students feel awkward, alienated and uncomfortable when confronted with a culture where registered nurses do not greet them. They are met by the attitude that Bauman refers to as "appropriate indifference," which means that the registered nurses act as if they neither see nor hear them because they are considered faceless private failures.

CONCLUSION

Nurses' non-greeting rituals in clinical placements counteract the creation of sustainable nursing education. The aim of this article is to contribute with knowledge about socially inappropriate non-greeting rituals and recommend friendly and socially sustainable education in clinical placements.

Stress in nurses: The 100 top-cited papers published in nursing journals

AIM

To identify and analyse the 100 most cited papers on stress in nurses published in nursing journals.

BACKGROUND

The number of citations an article receives is an index of its impact on the scientific community. An analysis of the most cited articles on stress in nursing would allow us to identify the most important articles and to obtain information about this area of knowledge.

DESIGN

A retrospective bibliometric analysis.

DATA SOURCES

In 2016, 111 journals belonging to the "nursing" category were identified in the Science and Social Science Citation Index. A search was performed of the Science Core Collection Website for articles on stress published in these journals.

REVIEW METHODS

The topic, type of article, publishing journal, countries and institutions of origin and year of publication were extracted from the articles. The impact factor, immediacy index, journal country and publisher and h index were collected from the Institute for Scientific Information. The citation density, citation tendency and Bradford's law were calculated.

RESULTS

They identified articles were mostly empirical quantitative studies with a transversal design, published from 1975 - 2011 in 23 journals. They were signed by 233 authors, most of whom are English-speaking from the USA and UK. The core distribution of the publications comprises a single journal, the Journal of Advanced Nursing.

CONCLUSION

The study of stress in nursing has shown increased visibility and recognition each decade. The most recent articles have the highest number of citations, are the highest in rank and have the higher citation densities.

Strategies to recruit and retain the nursing workforce in England

Nurses have become a scarce resource nationally and globally. In the United Kingdom senior nurses are beginning to assume responsibility for strategies to improve recruitment and retention, but there appears to be a lack of research to explore their role. Telephone interviews took place with 29 senior nurses throughout the summer of 2004. The response rate was high (80.5%), representing Trusts from all major regions in England. The data were analysed by content. All respondents had been appointed during the last five years and were experienced clinical nurses who had usually been employed in the same Trust before appointment. They were selected on the basis of their local knowledge and interpersonal skills. None had received formal preparation for the role, but all reported developing invaluable new skills ‘on the job’ since appointment. Respondents worked with human resource departments but instead of overlapping with traditional human resource functions, they offered a different perspective. This was possible because of their special knowledge of professional nursing issues. They had experience of international recruitment, but reported that organised campaigns were increasingly being replaced by initiatives to attract and retain staff locally, especially newly qualified nurses. This work was undertaken in conjunction with university staff. Respondents did not implement flexible working hours and family-friendly policies for existing staff, but worked with colleagues who assumed this responsibility. All handled speculative enquiries from potential recruits and in most Trusts vacancies were reported to be now mainly for experienced nurses, especially for very specialist clinical services. Postholders considered they were making an impact on staffing levels and enjoyed high levels of job satisfaction. Further research is needed to explore whether Trusts that employ dedicated nurses to address staffing issues are able to recruit and retain more effectively than those that do not. Research should be extended to include mental health and community Trusts in the United Kingdom as well as acute Trusts. Assuming that respondents' accounts are ‘trustworthy’, this study demonstrates senior nurses' ability to undertake advanced human resource management practice which is known to contribute to the success of organisations.

Seconding healthcare assistants to a pre-registration nursing course

Attrition from traditional pre-registration nursing programmes in the United Kingdom continues to be substantial and, once qualified, new staff nurses experience a number of challenges in adapting to their new role. A possible solution, strongly favoured by the current government, is to second existing healthcare assistants onto pre-registration programmes. The premise is that, because of their previous caring experience and exposure to work in the National Health Service, secondees will be more committed to complete training and will undergo role transition more effectively.

This paper presents an in-depth, qualitative study concerning the role transition of newly qualified staff nurses who had previously been employed as healthcare assistants. Uptake of the scheme had been substantially lower than anticipated, with only a small number of secondees eventually returning to their original wards. Secondees, their ward managers, percerptors and clinical practice facilitators were interviewed and the data were analysed employing the sequence for qualitative data analysis described by Miles and Huberman (1994). Findings suggest that healthcare-assistant secondment may not offer a ready solution to increasing the qualified nursing workforce. Contributory factors include: the length of time required for each newly qualified practitioner to qualify via the secondment route; the degree of commitment required on the part of secondees and university staff; the apparently limited benefits of previous healthcare-assistant experience; and personal costs to the secondees. Secondees described how they had been afraid of not completing the course successfully because of the public nature of failure if they were obliged to return to their original workplaces in the same role as before. This additional pressure has not been anticipated by proponents of secondment schemes and may help to explain why so few eligible candidates applied for secondment.

The effect of emotional freedom technique on stress and anxiety in nursing students: A pilot study

BACKGROUND

Stress and anxiety have been identified as significant issues experienced by student nurses during their education. Some studies have suggested that the stress experienced by nursing students is greater than that experienced by medical students, other non-nursing healthcare students, degreed nurses, and the female population in general. A recently introduced energy type therapy, emotional freedom technique (EFT), has shown some success in reducing symptoms of anxiety, stress, and fear in a variety of settings.

OBJECTIVE

The purpose of this study was to determine the efficacy of EFT in decreasing anxiety and stress as a potential intervention to assist students in stress management.

DESIGN

The study used a mixed method design of both qualitative and quantitative measures. Quantitatively, in a one group pretest-posttest design, participants received group instruction in the technique and were encouraged to repeat it daily. Self-reported anxiety was measured at baseline, and then weekly for four weeks using the Perceived Stress Scale (PSS) and the State-Trait Anxiety Inventory (STAI). The qualitative survey was completed by participants at the end of the study in order to capture a more subjective experience.

SETTING

The pilot study was conducted in a two-year college in the southeastern region of the United States.

PARTICIPANTS

All enrolled nursing students in an associate degree nursing program were invited to participate. Participation was voluntary, resulting in an original convenience sample of thirty-nine nursing students (N=39).

METHODS

Data collection instruments included a demographic questionnaire, pretest State-Trait Anxiety Inventory (STAI) and Perceived Stress Scale (PSS). A qualitative questionnaire was also administered at the end of the four weeks. STAI and PSS were administered weekly. Data analysis using RMANOVA was performed at the second, third and the fourth week.

RESULTS

Decreases in anxiety as measured on both the STAI and PSS were statistically significant (p=.05). For PSS, STAI state and trait data, the reduction in self-reported stress was statistically significant with a mean difference baseline to week 4. Qualitative data suggested that nursing students experienced a decrease in feelings of stress and anxiety including a decrease in somatic symptoms.

CONCLUSIONS

Overall, findings suggested that EFT can be an effective tool for stress management and anxiety relief in nursing students.

Clinical placement and case study methodology: a complex affair

Clinical placement is a valuable component of nursing education, helping students to authenticate, integrate and develop a range of nursing skills and knowledge. The diversity of nursing curricula throughout the world and the many models of clinical placement make this a difficult subject to research using typical qualitative and quantitative research methodologies. The potential for case study methodology to address the complexity of learning in the clinical environment is significant. This paper argues that Complexity Theory provides an interpretive paradigm that articulates well with case study methodology. This paper also provides an example of the development of a theoretical proposition based on pattern matching. Pattern matching is an approach to data analysis that encourages a consideration of predicted patterns with those that are empirically based.

Burnout during nursing education predicts lower occupational preparedness and future clinical performance: a longitudinal study

BACKGROUND

Early-career burnout among nurses can influence health and professional development, as well as quality of care. However, the prospective occupational consequences of study burnout have not previously been investigated in a national sample using a longitudinal design.

OBJECTIVES

To prospectively monitor study burnout for a national sample of nursing students during their years in higher education and at follow-up 1 year post graduation. Further, to relate the possible development of study burnout to prospective health and life outcomes, as well as student and occupational outcomes.

DESIGN

A longitudinal cohort of Swedish nursing students (within the population-based LANE (Longitudinal Analysis of Nursing Education/Entry) study) from all sites of education in Sweden was surveyed annually. Data were collected at four points in time over 4 years: three times during higher education and 1 year post graduation.

PARTICIPANTS

: A longitudinal sample of 1702 respondents was prospectively followed from late autumn 2002 to spring 2006.

METHODS

Mean level changes of study burnout (as measured by the Oldenburg Burnout Inventory, i.e. the Exhaustion and Disengagement subscales) across time, as well as prospective effects of baseline study burnout and changes in study burnout levels, were estimated using Latent Growth Curve Modeling.

RESULTS

An increase in study burnout (from 30% to 41%) across 3 years in higher education was found, and levels of both Exhaustion and Disengagement increased significantly across the years in education (p<0.001). Baseline levels, as well as development of study burnout, predicted lower levels of in-class learner engagement and occupational preparedness in the final year. At follow-up 1 year post graduation, earlier development of study burnout was related to lower mastery of occupational tasks, less research utilization in everyday clinical practice and higher turnover intentions.

CONCLUSIONS

The results suggest that study burnout may have interfered with learning and psychological well-being. Aspects related to work skills and intention to leave the profession were also affected. Thus, burnout development during higher education may be an important concern, and effective preventive measures to counteract burnout development may be necessary already at the outset of nursing education.

An exploration of personal, relational and collective well-being in nursing students during their training at a tertiary education institution

The well-being of nursing students has become crucial because of the multidimensional challenges that nursing professionals have to deal with. A community psychology framework was adopted in this study. The aim of the research was to explore the different dimensions of well-being as described by nursing students. A purposive and availability sample was used to gather qualitative data (interviews, focus groups and visual presentations) during 2008 and 2010 from first-year nursing students, which were thematically analysed. The emergent themes were grouped according to personal, relational and collective well-being. The findings indicated that nursing students’ personal well-being was undermined by a lack of autonomy, feelings of uncertainty, and feelings of pressure and disillusionment with the nursing profession and their training. Personal well-being was also described in terms of dispositional optimism and the need for a sense of purpose and deeper meaning. Relational well-being was expressed by the nursing students in relation to their friends, family and lecturers. The different relationships were important sources of comfort and encouragement. Their collective well-being was threatened by a challenging work environment, lack of role models in clinical settings as well as incongruence between theoretical training and practical application. Recommendations for improving the different dimensions of well-being are suggested.OpsommingDie welsyn van verpleegkundestudente het deurslaggewend geword as gevolg van die uiteenlopende uitdagings wat verpleegkundiges moet hanteer. ‘n Gemeenskapsielkunde raamwerk is in hierdie studie gebruik. Die doel van die navorsing was om die verskillende dimensies van welsyn van verpleegkundestudente te ondersoek. ‘n Doelgerigte en beskikbaarheidsteekproef is gebruik om kwalitatiewe data (onderhoude, fokusgroepe en visuele voorstellings) wat gedurende 2008 en 2010 van eerstejaar-verpleegkundestudente bekom is, deur middel van tematiese inhoudsontleding te analiseer. Die temas wat na vore gekom het, is gegroepeer volgens persoonlike, verhoudings- en gemeenskaplike welsyn. Die bevindinge het aangedui dat die verpleegkundestudente se persoonlike welsyn ondermyn word deur ‘n gebrek aan outonomie, gevoelens van onsekerheid en om onder druk te verkeer, asook ‘n ontnugtering met die verpleegkunde professie en opleiding. Persoonlike welyn is ook beskryf in terme van ‘n optimistiese ingesteldheid en die behoefte aan sinvolheid en ‘n dieper betekenis. Verhoudingswelsyn is deur die verpleegkundestudente uitgedruk in terme van hulle verhouding met hul vriende, familie en dosente. Die verskillende verhoudings word as belangrike bronne van ondersteuning en aanmoediging geag. Gemeenskaplike welsyn word bedreig deur ‘n uitdagende werksomgewing, die afwesigheid van rolmodelle in die kliniese omgewings asook die teenstrydigheid van die teoretiese opleiding met die praktiese toepassing daarvan. Aanbevelings vir die bevordering van welsyn in die verskillende dimensies word voorgestel.

Empowerment and being valued: a phenomenological study of nursing students' experiences of clinical practice

AIM

The aim of the study was to explore the empowerment of nursing students in clinical practice. This paper focuses on 'being valued' as an important element of empowerment.

BACKGROUND

Empowerment of nursing students is necessary in order for them to foster a sense of control and self-efficacy for those in their care. However, there is very little research on how to empower nursing students. Moreover, there is limited literature that specifically addresses the importance of students being valued in clinical practice.

METHODS

Thirteen, first-year nursing students were recruited using purposive sampling. Data were generated through the means of in-depth, semi-structured interviews. Hermeneutic phenomenology was chosen as the underpinning philosophical approach because of its emphasis on actual experiences.

FINDINGS

Being valued as a learner, being valued as a team member and being valued as a person are important factors in the empowerment of nursing students in clinical practice. These invariant themes are evident either implicitly or explicitly in the experiences of most students.

DISCUSSION

When nursing students are valued as learners, team members and people, they feel empowered. Too often however, they experience disempowerment as a result of feeling devalued. This has a detrimental impact on their learning and intention to continue on the programme. According to the accounts of many nursing students effective mentorship and a supportive environment are factors that influence empowerment significantly.

CONCLUSIONS

Strategies to promote the empowerment of nursing students in clinical practice need to address their sense of value.

A systematic review of the experiences and perceptions of the newly qualified nurse in the United Kingdom

AIM

A systematic literature review of the experiences and perceptions of newly qualified nurses in the UK during the transition from student to staff nurse.

BACKGROUND

It has been widely recognised that newly qualified nurses experience a period of transition. Over the past decade there has been radical reorganisation of nurse education in the UK which has raised issues of preparation for practice.

DATA SOURCES

Searches were made of the Cumulative Index to Nursing and Allied Health Literature (CINAHL) and MEDLINE.

METHODS

A systematic review was carried out. Papers were critically reviewed, relevant data were extracted and synthesised.

RESULTS

Four themes were identified from the empirical evidence base: transition and change, personal and professional development, pre-registration education, preceptorship and support.

CONCLUSION

Transition remains a stressful experience for newly qualified nurses in the UK. Reasons include an increase in personal and professional development, changes in pre-registration education and lack of support once qualified.

RECOMMENDATIONS

Further research is needed to address the current situation in relation to the transition period including pre-registration education, preparation for practice and support in both primary and secondary care.

Change in depressive symptoms over higher education and professional establishment - a longitudinal investigation in a national cohort of Swedish nursing students

Background

There are indications of a high prevalence of psychological distress among students in higher education and also that distress increases over the course of study. However, not all studies on student distress controlled for sociodemographic differences and few followed development of distress over an extended period through professional establishment. We investigated if there is an independent effect of time in education and the first two years in the profession on depressive symptoms and mapped change over the period in a national cohort of students.

Methods

Data came from LANE, a nation-wide longitudinal panel survey of Swedish nursing students (N = 1700) who responded to annual questionnaires over five years from 2002 to 2007. Depressive symptoms were measured by the Major Depression Inventory and change over time analysed in a linear mixed effects model for repeated measures.

Results

There was a significant change in level of depressive symptoms over time: an increase from the first to later years in education and a decrease to levels similar to baseline after graduation and a year in the profession. The change in symptoms remained significant after adjustment for sociodemographic factors (p < 0.01). Symptom levels differed due to age, gender, household composition and prior nurse assistant training but change over time was similar in all groups. The correlation among the repeated measures, representing within individual correlation over time, varied between 0.44-0.60.

Conclusions

The findings indicate an independent but transitional effect of time in education and professional establishment on depressive symptoms. We think heightened distress over education abates as the graduate accommodates to the profession. Nevertheless, within education, the differences in depressive symptoms associated to demographic factors can help identify student groups more vulnerable to distress. Also, as individual differences in distress seem to persist over time, perhaps students highly distressed in the beginning of education can be helped by awareness among educators of the elevated levels of distress in late education.

A longitudinal study of stress and self-esteem in student nurses

INTRODUCTION

It is well recognised that nurse education/training can be a stressful experience and that self-esteem is an important predictor of stress. BACKGROUND/LITERATURE: While there are a significant number of studies showing levels and contributors to stress among students. There is little evidence of how these levels change over time. The aim of the study was to investigate nursing students' experiences of stress and levels of self-esteem during three years of their undergraduate nursing programme.

METHODS

Participants completed the stress in nurse education questionnaire and the culture free self-esteem inventory at various time points in the study, and a demographic questionnaire at baseline. The students who took part in the study commenced their nurse training in September 2002.

DATA/RESULTS

This study has demonstrated that levels of self reported stress and "general" self-esteem are significantly different at different stages the nurse training process. Self reported stress were at the highest at the beginning of the third year and these were significantly higher when compared to stress reported at any other time point. Self-esteem levels were lowest at the end of training.

CONCLUSIONS

Trying to obtain data only at single time point during nurse education/training is inadequate as this research has shown that there is indeed variation in student psychological well being across the academic year.

Exploring the information and communication technology competence and confidence of nursing students and their perception of its relevance to clinical practice

AIM

This paper profiles a study that explored nursing students' information and communication technology competence and confidence. It presents selected findings that focus on students' attitudes towards information and communication technology as an educational methodology and their perceptions of its relevance to clinical practice.

BACKGROUND

Information and communication technology is integral to contemporary nursing practice. Development of these skills is important to ensure that graduates are 'work ready' and adequately prepared to practice in increasingly technological healthcare environments.

METHODS

This was a mixed methods study. Students (n=971) from three Australian universities were surveyed using an instrument designed specifically for the study, and 24 students participated in focus groups.

FINDINGS

The focus group data revealed that a number of students were resistant to the use of information and communication technology as an educational methodology and lacked the requisite skills and confidence to engage successfully with this educational approach. Survey results indicated that 26 per cent of students were unsure about the relevance of information and communication technology to clinical practice and only 50 per cent felt 'very confident' using a computer.

CONCLUSION

While the importance of information and communication technology to student's learning and to their preparedness for practice has been established, it is evident that students' motivation is influenced by their level of confidence and competence, and their understanding of the relevance of information and communication technology to their future careers.

Undergraduate nursing students' level of assertiveness in Greece: a questionnaire survey

BACKGROUND

A number of studies of nursing and midwifery have found stress and bullying to be frequent problems. Those suffering from bullying and stress need to have high levels of assertiveness to resist and to cope successfully. Hence, it was considered vital to assess the assertiveness level of nursing students throughout their training curriculum.

METHODS

The study population was composed of nursing students in different semesters at one school in Central Greece (n=298) who agreed to complete a questionnaire on assertiveness level assessment, which had been translated into Greek and adapted to this population. All students present in class completed the questionnaire, representing 80% of the total population of active students. Mean assertiveness scores between semesters were compared by ANOVA and comparisons between the responses of the first semester students and responses of advanced semester students were done by Pearson's chi square.

RESULTS

The main finding of this study was that the assertiveness levels displayed by students increase slightly in advanced semesters by comparison to those displayed by first-semester students.

CONCLUSIONS

Assertive behavior should be encouraged through learning methods. Nurses should preferably obtain this training throughout their studies. Instructors have an essential role in the improvement and achievement of assertiveness training curriculums for undergraduate nursing students.

A comparative, longitudinal study of stress in student nurses in five countries: Albania, Brunei, the Czech Republic, Malta and Wales

BACKGROUND AND AIMS

Stress amongst nursing students is a global issue. There is an absence of published international comparative studies which investigate this and so this paper sets out to explore the sources of stress among nursing students throughout their course of study and to determine whether they were more stressed by academic or clinical factors across five different countries (Albania, Brunei, the Czech Republic, Malta and Wales). Although each country, within this study, has a unique culture, a cross-cultural comparison can be made in an attempt to better understand stress in the student nursing population.

METHODS

The study was undertaking using a descriptive quantitative design using the Stress in Nurse Education Questionnaire with 1707 nursing students across the five countries.

RESULTS

The mean score for the total sample for all the items on the stress scale was 52.3 (SD 17.1). The sample from Wales had the lowest mean score and those in Brunei had the highest. Students in Brunei and Malta were more stressed by the academic elements of the course than by the clinical elements. Whereas for those students in the Czech Republic For students in Wales and in Albania - Korçe there were no differences in stress experienced between the academic and clinical elements of the course. The results indicated that there were no significant differences in total stress scores by year of study for students in Albania - Tirana, Albania-Korçe, Malta and Wales. In Brunei however, ANOVA revealed that there were significant differences in total stress scores by year of study. Further analysis revealed that students in year 3 scored higher on the overall scale than students in year 1. The individual item on the stress scale with highest mean in the Albania - Korçe and the Albania-Tirana sample was "The death of a patient" whilst the Bruneian sample, Maltese sample and Welsh sample opted for "Revising for and sitting examinations" and the Czech sample chose: "Continuous pressure to meet deadlines for assessments".

CONCLUSIONS

This study has succeeded as the first of its kind to compare and contrast levels and sources of stress amongst an international sample. The findings indicate that student nurses worldwide do share much in common while still retaining individual cultural features relating to stress throughout their course of study.

An exploratory study identifying the programme related stressors amongst qualified nurses completing part-time degree courses

The aim of this paper is to explore the leading programmatic stressors and associated age related stressors experienced by two cohorts of students (n=132) completing part time degree programmes in nursing in two third level institutions in the Republic of Ireland. To date the literature has exclusively focused on the day to day stressors that undergraduate nursing student's experience. The design chosen was descriptive utilising a questionnaire as the mode of data collection. 'Preparing assignments for submission', 'trying to balance work commitments and the required study', 'doing the course assignments', 'the demands of writing an assignment to the necessary level', the prospect of the final examination' and 'preparing for the course examination' were all ranked as the leading stressors. The younger participants in this study were more likely to register higher degrees of stress as a result of the process stressors of their studies owing to the negative correlation with age. Process stressors were associated with the academic workload and time management difficulties. The findings have wider implications for educationalists in relation to course development and ongoing student support. Educationalists need to be cognizant in particular of the age related stressors associated with completing part time degree programmes.

The impact of ongoing continuing professional development for nurses in the Republic of Ireland

AIM

The aim of this study was to explore and describe the stressors experienced by a group of 70 students who were undertaking a part-time degree in an Irish University.

BACKGROUND

Within the literature on stress, part-time nursing students, who are undertaking continuing education programmes, appear to have received little attention. Stress amongst nurses is evident within the nursing literature but little information is available on the specific stressors that affect Registered Nurses who attend further academic study. Furthermore, there is little attention given to comparisons across faculty or between different institutions.

METHOD

The authors used quantitative methods to gather a large amount of data on the topic. Data were collected using questionnaires distributed to two groups of students in a classroom setting.

RESULTS

The top ranking stressor was 'preparing an assignment for submission'. Nursing students were predominantly exposed to stressors associated with assignment completion/submission and balancing work and family commitments. Differences emerged between the groups with regard to the intensity of perceived stressors in relation to academic portions of the programme and also finance. Nine major factors emerged from factor analysis that may form the basis for future studies in this area. Areas related to lectures, relationships with lecturers and the course process were not identified as stressors.

CONCLUSION

The results of this study identified common student stressors across two universities, and confirmed the findings of an initial small exploratory study. The intensity of perceived stress is such that both educators and nurse managers need to be informed of both its magnitude and its possible impact upon clinical practice. In addition, additional student support structures are clearly required within the university setting particularly with regards to writing skills and assignment construction.

Pedagogy, power and practice ethics: clinical teaching in psychiatric/mental health settings

Often, baccalaureate nursing students initially approach a psychiatric mental health practicum with uncertainty, and even fear. They may feel unprepared for the myriad complex practice situations encountered. In addition, memories of personal painful life events may be vicariously evoked through learning about and listening to the experiences of those diagnosed with mental disorders. When faced with such challenging situations, nursing students often seek counsel from the clinical and/or classroom faculty. Pedagogic boundaries may begin to blur in the face of student distress. For the nurse educator, several questions arise: Should a nurse educator provide counseling to students? How does one best negotiate the boundaries between 'counselor', and 'caring educator'? What are the limits of a caring and professional pedagogic relation? What different knowledges provide guidance and to what differential consequences for ethical pedagogic relationships? This paper offers a comparative analysis of three philosophical stances to examine differences in key assumptions, pedagogic positioning, relationships of power/knowledge, and consequences for professional ethical pedagogic practices. While definitive answers are difficult, the authors pose several questions for consideration in discerning how best to proceed and under what particular conditions.

Determining problems experienced by student nurses in their work with clinical educators in Turkey

Clinical education is considered an indispensable and vital part of nursing education. Educators have an important role in the successful completion of a student's clinical education. The clinical educator's approach, experience and knowledge have an influence on the students. Students encounter certain problems during their clinical practice under the supervision of educators. This study was conducted to determine the nature of the problems student nurses encounter during clinical training in Turkey. The focus-group interviews were used for this study. Three groups of 8, a total group of 24, composed of students completing their third year were included in the interviews. The students in this study had completed their practical training in the departments of internal medicine, surgery, pediatrics, psychiatry and public health. Among the problems mostly encountered by students, as established by the study, were inadequate assessment by the clinical educator, judgment, negative feedback, communication problems, inadequate guidance and overload. At the end of the research, recommendations were that educators should offer information in the direction of student expectations, increase their positive feedback and lighten the academic workload of these students.

The meaning of empowerment for nursing students: a critical incident study

AIM

This paper is a report of a study to explore the meaning of empowerment for nursing students in relation to their clinical practice experiences.

BACKGROUND

Empowerment and power are well-researched areas of nursing practice, particularly in relation to Registered Nurses. Furthermore, several studies have considered the experiences of nursing students in terms of nursing culture and socialization. However, few researchers have focused specifically on nursing student empowerment.

METHOD

The critical incident technique was used and anonymous data were collected between November 2005 and January 2006. One hundred and nine written critical incidents were provided by 66 nursing students relating to empowering and disempowering experiences in clinical practice. The data were content analysed.

FINDINGS

Nursing students experience both empowerment and disempowerment in clinical placements, centring on three issues: learning in practice, team membership and power. Continuity of placement, the presence of a mentor and time underpinned empowering experiences whereas their absence had a disempowering effect.

CONCLUSION

The consequences of nursing student empowerment are high self-esteem, motivation for learning and positive regard for placement. Supportive mentors play a pivotal role in the empowerment of nursing students and it is essential for the nursing profession that they are supported to undertake their mentorship role.

The relationship between emotional intelligence, occupational stress and health in nurses: a questionnaire survey

BACKGROUND

Nurses suffer from stress and health problems owing to the characteristics of their work and their contact with patients and death. Since emotions can have an effect on work outcomes, emotional intelligence (EI) may explain the individual differences in dealing with work stress.

OBJECTIVES

This study investigated the interrelationships among EI, work stress and health. We also examined the impact of socio-demographic variables (e.g. age, gender, length of service,...) on stress and nurses' health.

DESIGN

A questionnaire survey (anonymous) has been carried out to detect these interrelationships.

SETTING

A general public hospital in Spain

PARTICIPANTS

One hundred and eighty nurses.

METHODS

Data was gathered on demographic information and work, stress, health and EI. Beyond descriptive statistics, analyses of variance, mean differences and regression analyses were computed.

RESULTS

Findings show a differential effect of the EI components in stress and health. As far as stress is concerned, the results show that the nurses who score high in clarity and emotional repair report less stress, whereas those with high scores in attention to emotions experience greater levels of stress. Furthermore, we find a positive relationship between age, length of service and stress, with younger nurses and those with a shorter length of service experiencing less stress. However, EI and health are not related to age or to length of service. Also, we find that married nurses report better general health.

CONCLUSIONS

EI is shown for nurses as a protective factor against stress and a facilitative factor for health (especially the Clarity and Repair dimensions). These comments could be especially important in training future professionals in these abilities.

Belongingness: A critique of the concept and implications for nursing education

Clinical experience is recognised as central to nursing education. Quality clinical placements across a range of venues are vital to the development of competent and confident professionals. However there is evidence, both empirical and anecdotal, suggesting that nursing students' clinical placement experiences are often fraught with problems. These problems are long standing and multi-dimensional. For many students clinical placements are typified by feelings of alienation and a lack of belongingness. This paper proposes that the problematic nature of clinical placements may be better understood through the lens of 'belongingness'. A critical review of selected studies drawn from the psychological and social science literature provides insight and useful direction for a more focused review of the nursing literature. The potential relationships between belongingness, nursing students, and their clinical placement experiences are then exemplified by excerpts taken from the nursing literature (including unpublished material). Finally, an ongoing study that seeks to address the paucity of empirical research in this area is highlighted.

Exploring the relationship between perceived emotional intelligence, coping, social support and mental health in nursing students

Studies conducted with nurses or nursing students have shown that emotional intelligence is a skill that minimizes the negative stress consequences. The present work examines the role of perceived emotional intelligence (PEI) measured by the Trait Meta-Mood Scale, in the use of stress-coping strategies, in the quantity and quality of social support and in the mental health of nursing students. The results indicated positive correlations between clarity and social support, social support and repair, and social support and mental health. Hierarchy regression analysis pointed out that clarity and emotional repair are predictors of social support, and emotional repair is the main predictor of mental health. These results show the importance of PEI in stress coping within the nursing framework.

Locally targeted initiatives to recruit and retain nurses in England

AIM

The aim of this study is to provide a detailed account of the locally targeted strategies to improve staffing levels by senior nurses responsible for recruitment and retention in acute trusts in the National Health Service in England.

BACKGROUND

There is a shortfall in nursing numbers throughout England. Some trusts have employed senior nurses with a specific remit to improve recruitment and retention, but little has been published about their work or its success.

METHODS

Data were collected by telephone using semi-structured interviews with standard probes. The tape-recorded interview data were transcribed verbatim and analysed by content.

RESULTS

Of the 156 acute trusts in England, 36 employed a senior nurse to deal with recruitment and retention. Twenty-nine were interviewed. All were using a range of locally targeted initiatives to attract and retain health-care assistants, newly qualified and more experienced practitioners. They also worked closely with university staff to attract and retain student nurses who would later seek employment locally. Different approaches were used to secure the services of different types of staff.

CONCLUSION

This exploratory study has revealed a wealth of valuable data concerning locally targeted recruitment and retention strategies. Further research is needed to examine the effectiveness and cost-effectiveness of the initiatives described.

Autogenic training to reduce anxiety in nursing students: randomized controlled trial

AIM

This paper reports a study to determine the effectiveness of autogenic training in reducing anxiety in nursing students.

BACKGROUND

Nursing is stressful, and nursing students also have the additional pressures and uncertainties shared with all academic students. Autogenic training is a relaxation technique consisting of six mental exercises and is aimed at relieving tension, anger and stress. Meta-analysis has found large effect sizes for autogenic trainings intervention comparisons, medium effect sizes against control groups, and no effects when compared with other psychological therapies. A controlled trial with 50 nursing students found that the number of certified days off sick was reduced by autogenic training compared with no treatment, and a second trial with only 18 students reported greater improvement in Trait Anxiety, but not State Anxiety, compared with untreated controls.

METHODS

A randomized controlled trial with three parallel arms was completed in 1998 with 93 nursing students aged 19-49 years. The setting was a university college in the United Kingdom. The treatment group received eight weekly sessions of autogenic training, the attention control group received eight weekly sessions of laughter therapy, and the time control group received no intervention. The outcome measures were the State-Trait Anxiety Inventory, the Maslach Burnout Inventory, blood pressure and pulse rate completed at baseline, 2 months (end of treatment), and 5, 8, and 11 months from randomization.

RESULTS

There was a statistically significantly greater reduction of State (P<0.001) and Trait (P<0.001) Anxiety in the autogenic training group than in both other groups immediately after treatment. There were no differences between the groups for the Maslach Burnout Inventory. The autogenic training group also showed statistically significantly greater reduction immediately after treatment in systolic (P<0.01) and diastolic (P<0.05) blood pressure, and pulse rate (P<0.002), than the other two groups. CONCLUSION. Autogenic training has at least a short-term effect in alleviating stress in nursing students.

A pilot data collecting exercise on stress and nursing students

This article discusses the lessons learned from a small pilot study exploring the link between the working environment and occupational stress among groups of nursing students. A comparative descriptive design was adopted to examine, describe and compare the two variables (sources and frequency) in three groups of nursing students. The sample comprised 90 students from one large inner-city school of nursing in London. The Expanded Nursing Stress Scale questionnaires were used to collect the data. The main findings suggest that the adult, child and mental health branch students were similar with respect to overall frequency of occupational stress. Areas of commonality and variability in the sources of stress perceived by the three groups of students were identified. A pilot study is a crucial element of a good study design. Areas of concern, lessons learned and suggested refinements were identified.

Stressors associated with qualified nurses undertaking part-time degree programmes - some implications for nurse managers to consider

The aim of this exploratory study was to explore and describe aspects of the programme that caused stress to students and suggested measures for reducing this stress. Perceived personal and professional benefits were also explored. A descriptive exploratory study utilizing a survey design was utilized. Stressors associated with the programme included trying to balance work commitments and the required study emerged as the number one stressor. "Balancing" was a significant feature of many of these nurses' lives. Meeting work commitments in addition to study was a reported stressor for almost every nurse. Employers and managers within the health care setting need to be responsive to the needs of nurses undertaking postregistration study, and explore flexible working options and aim to provide support and encouragement to nurses who are motivated towards study. Results indicate overall benefits for both the nurses' personal and professional practice, therefore adequate infrastructure to suitably support these nurses is required that may have potential benefits for patient/client care.

Working in London hospitals: Perceptions of place in nursing students’ employment considerations

During the past decade, a distinct body of research has started to investigate the dynamics between nursing and place. However, despite attention being paid to a wide-range of nursing subjects, few studies have engaged with the important topic of labour force recruitment. In this context, this study uses a combined questionnaire (n=650), interview (n=30) and focus group (n=7) survey of London-based students, and investigates the complex mix of experiences and perceptions that result in hospitals having varying degrees of popularity as potential workplaces. The findings suggest experiences and perceptions of institutions-often gained on clinical placements-to be important, particularly relating to feeling valued, the quality of patient care, clinical and educational opportunities and team cohesion. These are often combined with experiences and perceptions of locality, relating to factors such as cost of living, travel considerations and sense of personnel safety. The study demonstrates that place is relevant to employment decision-making on multiple scales from wards to regions. Furthermore, that perceptions of potential workplaces result from engagements with complex mixes of cultural, economic and physical features, many of which are the consequences of management. It is argued that in order to effectively unpack workplaces, geographical research of nursing labour may benefit from researching simultaneously both 'inside' institutions, focusing on their dominant cultures of production and sub-cultures, and 'outside', focusing on their local urban or rural contexts.

Personal tutors' views of their role with pre-registration nursing students: an exploratory study

The focus of this article is an exploratory qualitative study which examined personal tutors' views of their role within pre-registration nurse education. Following review of relevant literature and gaining ethical approval a sample of 10 personal tutors was purposively selected from the teaching staff at a University in the UK. Each personal tutor agreed to participate in an audio taped one-to-one, face-to-face, in-depth interview. Data were analysed using a thematic content analysis approach. Data themes identified included, the role of the personal tutor; perceptions of personal students; student attendance and progress issues and responding to issues disclosed by personal students. These themes were underpinned by the perceived over-riding importance in providing support to personal students. The unpopular patient syndrome is contrasted and compared with perceptions of successful and unsuccessful students. Whilst an all encompassing system of personal tutor support may require a high commitment of time and people resources it remains an important support mechanism for students.

Programme-related stressors among part-time undergraduate nursing students

AIM

The aim of this paper is to report a study exploring the perceived stressors identified by a group of 70 students who undertook a part-time degree at one Irish university.

BACKGROUND

In the literature on stress, part-time nursing students who are undertaking continuing education programmes appear to have received little attention. Stress amongst nurses is evident within the nursing literature but little information is available on the specific stressors that affect Registered Nurses who undertake further academic study. Anecdotally, students attending part-time programmes while working full-time report high levels of stress.

METHOD

Quantitative methods were used. While many instruments exist to measure overall stress, this study aimed to explore student's perceptions of specific stressors associated with academic study. We used a questionnaire developed from the literature on the topic.

RESULTS

Factors related to writing assignments at degree level, fulfilling personal needs and academic demands, were perceived as major stressors by these students. Factors of little concern were financial issues and attendance on the programme. Individual items receiving highest mean scores were: trying to balance work commitments and the required study (mean 3.89, sd = 1) and the prospect of the final examination (mean 3.86, sd = 1). This study was limited by the use of convenience sampling and self-report methods. Larger studies are required to support the findings. In addition, student stress was not observed or measured.

CONCLUSION

Those involved in the delivery of nurse education programmes to part-time students need to consider the impact of the workload on student welfare, and to prepare students for demands of the programme.

Perceptions of nursing: confirmation, change and the student experience

Research has identified a number of negative societal perceptions of nursing related to gendered stereotyping, subordination to doctors, low academic standards, limited career opportunities and poor pay and conditions, and importantly how these perceptions may affect levels of recruitment into nursing. Focusing specifically on nurses, research has also considered the extent to which these societal perceptions are realities in their workplaces, and the direct experiences that contribute to attrition from both nursing courses and jobs. However, to date, few research has actually bridged the above approaches and considered the perceptions that nursing students hold as they first enter their education and how these change, or are confirmed, as a result of their experiences. In this context, the current study uses a combined questionnaire (n = 650), interview (n = 30) and focus group (n = 7) methodology to investigate the experiences of students based at two British Universities. The findings suggest that many students were surprised, yet not overwhelmed, by the high academic standards required of them and came to recognize and value the tremendous knowledge, skills set and responsibilities of nurses as they acquired them. However, their experiences reinforced both society's and their own image of an underpaid, overworked profession that lacks respect and has low morale. The findings support media initiatives that emphasize nurses' skills in order to influence public opinion. They also support a range of subtle changes in nurse education at the institutional level to make student life easier. Nevertheless, it is acknowledged that these may have a limited impact unless pay and conditions are adequately addressed at the national level.

Irish nursing students' changing levels of assertiveness during their pre-registration programme

BACKGROUND

Stress and bullying have been found to be common problems in a number of studies of Irish nursing and midwifery. Victims of bullying need high levels of assertiveness to enable them to withstand the stress of victimization. It was deemed important to measure nursing students' level of assertiveness prior to, and near completion of, their pre-registration education programme. Aim. To ascertain nursing students' perceived levels of assertiveness prior to, and nearing the completion of, their three-year pre-registration programme.

METHODS

Ethical approval was given. The students commencing general nurse education programmes in two schools in Southern Ireland agreed to take part (n=72). A questionnaire adapted from a number of assertiveness scales, and tested for validity and reliability in this population, was used to collect data.

RESULTS

In general, students' reported assertiveness levels rose as they approached completion of their three-year education programme.

DISCUSSION

The resource constrained health service of the 21st century requires nurses who are assertive to meet the needs of its users. Nursing students' assertiveness skills could be augmented through concentrated efforts from nurse educationalists and clinicians to reduce the communication theory practice gap in nurse education today. To address the multi-dimensional nature of assertiveness, strategies to increase assertiveness should operate at the individual, interface and organisational level.

CONCLUSIONS

The students in this study reported an increase in levels of assertiveness as they approached completion of their three-year education programme. To function as effective, safe practitioners registered nurses need to be assertive, therefore education in assertiveness should be an integral part of their preparation. The precise composition and mode of delivery of this education requires exploration and evaluation.

Pre-registration diploma student nurse stress and coping measures

The aim of this study is to examine the stress experiences and coping abilities of student nurses. A survey design was employed to examine the stress experiences of Diploma student nurses in a large Dublin Teaching Hospital. A questionnaire was utilized that measured and explored five specific constructs pertinent to student nurse stress. These included clinical stress, academic stress, coping, emotions and personal factors which assist students nurses during periods of stress. Findings showed that examinations, the level and intensity of academic workload, the theory-practice gap and poor relationships with clinical staff were the leading stressors identified. Emotional reactions to stress included feeling exhausted and upset under pressure. Students adopted short-term emotion focused coping strategies when attempting to deal with stress. A sense of achievement, and determination, were personal factors, which assisted students to continue in the event of stress being present. Content analysis of the open questions shed further light in relation to the stress phenomenon, particularly in relation to clinical stress. The provision of adequate support services from a clinical and academic perspective, a lecture-practitioner model of education delivery, and curriculum changes which focus on developing student self awareness skills are the suggested study recommendations.

Mature women's experiences of preregistration nurse education

BACKGROUND

The government of the United Kingdom is encouraging more flexible recruitment strategies to overcome the shortage of qualified nurses. Mature women returning to education, often after completing their families, are a major target, but there has been little evaluation of their experiences as higher education students of nursing.

AIM

The aim of the study was to follow-up a previous quantitative study of mature women students' outcomes on preregistration diploma courses in order to gain a deeper understanding of their experiences, and consider ways in which their needs might be addressed.

METHODS

Five focus groups were conducted in one higher education institution, and data were analysed using thematic analysis, assisted by the 'spike' feature of Word for Windows.

FINDINGS

Three major themes were identified: 'Didn't know what to expect', 'Reality shock' and 'Learning the game'. Subthemes of 'Learning the game' were 'Academic study', 'Practice placements and shift work', 'Managing the effect of course workload on domestic roles', 'Personal growth and changing relationships', and 'Support systems and friendships'.

CONCLUSIONS

The findings are discussed in relation to reports of women's experiences in higher education in general. We conclude that the situation and needs of mature women preregistration nursing students are such that fundamental curriculum redesign is needed so that they can participate in higher education in ways that allow integration of their family and student lives, and permit them to benefit from the higher education experience in the same ways as younger students. The study is limited by its local nature, but the findings mirror those of other work, giving reassurance of its wider applicability. Recommendations are made for changes in the philosophy and organization of future programmes to improve their appropriateness and acceptability to mature women nursing students.